Provider Demographics
NPI:1154354751
Name:BEARD, JOAN M (NP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:BEARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9045 JAREAU AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4000
Mailing Address - Country:US
Mailing Address - Phone:651-458-3350
Mailing Address - Fax:
Practice Address - Street 1:2854 HIGHWAY 55
Practice Address - Street 2:SUITE 190
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2156
Practice Address - Country:US
Practice Address - Phone:651-644-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1146523363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S66823Medicare UPIN