Provider Demographics
NPI:1144250747
Name:RICH, BEVERLY WALDMAN (APRN, BC)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:WALDMAN
Last Name:RICH
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:POTTER 3
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-4318
Mailing Address - Fax:401-444-6573
Practice Address - Street 1:1011 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-5061
Practice Address - Country:US
Practice Address - Phone:401-432-1022
Practice Address - Fax:401-432-1500
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00034363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30177-0OtherBLUE CROSS
RI7245176OtherAETNA HEALTHCARE
RIBR10812Medicaid
RI62-15753OtherUNITED BEHAVIORAL HEALTH
RI406699OtherBLUE CHIP