Provider Demographics
NPI:1699067355
Name:MOUNTJOY, BEVERLY JEAN (RNC)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JEAN
Last Name:MOUNTJOY
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 65
Mailing Address - Street 2:402 SR 72
Mailing Address - City:REESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45166
Mailing Address - Country:US
Mailing Address - Phone:937-208-2007
Mailing Address - Fax:937-208-2752
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-2007
Practice Address - Fax:937-208-2752
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN149833163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse