Provider Demographics
NPI:1124111380
Name:BEAZLIE, LEWIS HENRY III (RN, CNP, BC, CARN-AP)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:HENRY
Last Name:BEAZLIE
Suffix:III
Gender:M
Credentials:RN, CNP, BC, CARN-AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:588 MEREDITH LN
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-2591
Mailing Address - Country:US
Mailing Address - Phone:330-926-1662
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:CVAMC VARC SA(W)
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:216-421-3218
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHNP-03858363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health