Provo, Beverly J

Provo, Beverly J is an individual health care provider with primary practice located at 1208 Driving Park Ave , Newark NY 14513-1057. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Provo, Beverly J can be contacted via phone (315) 359-2640.

Contact Information

Primary practice address
1208 Driving Park Ave Newark NY 14513-1057
Phone: (315) 359-2640
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X F3041711 New York
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X F3403661 New York

Profile Details

NPI number 1215096482
LBN Legal business name Provo, Beverly J
Credentials GNPC
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 6th, 2006
Last updated Jan 6th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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