Individual
GRACE ELIZABETH BEAUCHAMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
636 MIDDLE COUNTRY RD, SELDEN, NY 11784-2500
(631) 707-6223
Mailing address
7 SWISSTONE ST, MEDFORD, NY 11763-4105
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
305575
NY
Other
Enumeration date
04/19/2018
Last updated
04/19/2018
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