Breona S Beverly
Individual provider Active NPI Licensed Vocational Nurse · Ceres, CA
NPI 1194243626 · NPPES record last updated Sep 5, 2017
Key facts
- NPI
- 1194243626
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Vocational Nurse 164X00000X
- License
- 688761 (CA)
- Practice address
- 1904 Richland Ave
Ceres, CA 95307-4562 - Phone
- (209) 300-8800
- NPI assigned
- Sep 5, 2017
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 688761 | CA | MD | Licensed Vocational Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 688761 | CA | Yes |
Addresses
Primary practice location
1904 Richland Ave
Ceres, CA 95307-4562
Mailing address
1123 Cedar Creek Dr Unit 4
Modesto, CA 95355-5228
Other providers in Ceres, CA
- Rosalinda Bedoy
- Sherry Lynn Beier
- Magdalena Nena Beltran
- Donna Marie Benjamin
- Nahrain Colleen Benner
- Leslie N.C. Bezner
- Romio Bhatia
- BHRS
- Gurpreet Kaur Bhullar
- Hoang Bien
All providers in Ceres, CA · Licensed Vocational Nurse in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.