Provider Demographics
NPI:1720769425
Name:BEAVERS, PAMELA A
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:BEAVERS
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:POTTER
Mailing Address - State:NE
Mailing Address - Zip Code:69156-0189
Mailing Address - Country:US
Mailing Address - Phone:308-879-4434
Mailing Address - Fax:
Practice Address - Street 1:303 WALNUT ST
Practice Address - Street 2:
Practice Address - City:POTTER
Practice Address - State:NE
Practice Address - Zip Code:69156-1066
Practice Address - Country:US
Practice Address - Phone:083-879-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion