Provider Demographics
NPI:1306422951
Name:NATHAN, BEVERLY (RN)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:NATHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:GOLD
Other - Last Name:NATHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BEVERLY GOLD NATHAN
Mailing Address - Street 1:50 FREEDOM HOLW UNIT 412
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-6627
Mailing Address - Country:US
Mailing Address - Phone:617-461-4661
Mailing Address - Fax:
Practice Address - Street 1:50 FREEDOM HOLW UNIT 412
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-6627
Practice Address - Country:US
Practice Address - Phone:617-461-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN12156163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse