Provider Demographics
NPI:1538366257
Name:MONTALVO, BEVERLY ANNE (FNP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANNE
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BEVER;U
Other - Middle Name:ANNE
Other - Last Name:CLAPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-9500
Mailing Address - Fax:910-662-9501
Practice Address - Street 1:584 HOSPITAL DR NE UNIT E
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-0020
Practice Address - Country:US
Practice Address - Phone:910-662-9500
Practice Address - Fax:910-662-9501
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010115363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner