Provider Demographics
NPI:1063564573
Name:WERTH, BEVERLY M (RN)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:M
Last Name:WERTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:M
Other - Last Name:ARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2133 MILL CROSSING DR APT 214
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-1260
Mailing Address - Country:US
Mailing Address - Phone:219-877-7073
Mailing Address - Fax:
Practice Address - Street 1:2133 MILL CROSSING DR APT 214
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-1260
Practice Address - Country:US
Practice Address - Phone:757-961-6561
Practice Address - Fax:757-961-6593
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28086215A163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management