Provider Demographics
NPI:1407023237
Name:MASSEY, BEVERLY ANN (LPN)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:ANN
Last Name:MASSEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:ANN
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:12 BROMPTON CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-4003
Mailing Address - Country:US
Mailing Address - Phone:608-274-6891
Mailing Address - Fax:
Practice Address - Street 1:12 BROMPTON CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-4003
Practice Address - Country:US
Practice Address - Phone:608-274-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25360-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35044100Medicare PIN