Provider Demographics
NPI:1033928205
Name:FAIRMAN, BEANVA (LVN)
Entity type:Individual
Prefix:
First Name:BEANVA
Middle Name:
Last Name:FAIRMAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:BEANRA
Other - Middle Name:
Other - Last Name:FAIRMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:935 FILBERT ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3111
Mailing Address - Country:US
Mailing Address - Phone:510-435-2413
Mailing Address - Fax:
Practice Address - Street 1:700 ADELINE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2608
Practice Address - Country:US
Practice Address - Phone:510-835-9610
Practice Address - Fax:510-900-8830
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA739873164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse