Provider Demographics
NPI:1104101294
Name:MATHERS, BEVERLIE ANN (RN)
Entity type:Individual
Prefix:MS
First Name:BEVERLIE
Middle Name:ANN
Last Name:MATHERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:BEVERLIE
Other - Middle Name:ANN
Other - Last Name:MATHERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1601 N 84TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-1511
Mailing Address - Country:US
Mailing Address - Phone:402-502-7588
Mailing Address - Fax:
Practice Address - Street 1:2010 N 88TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6102
Practice Address - Country:US
Practice Address - Phone:402-496-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62688163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse