Provider Demographics
NPI:1366913386
Name:BEGLEY LAVERY, BARBARA L
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:BEGLEY LAVERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 EDISON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2285
Mailing Address - Country:US
Mailing Address - Phone:810-228-8665
Mailing Address - Fax:
Practice Address - Street 1:1430 MILITARY ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5912
Practice Address - Country:US
Practice Address - Phone:810-984-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704167982163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse