Provider Demographics
NPI:1538813902
Name:BEYER, CARRIE (RN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BEYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10641 W GRANTOSA DR
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2208
Mailing Address - Country:US
Mailing Address - Phone:414-758-9696
Mailing Address - Fax:
Practice Address - Street 1:10641 W GRANTOSA DR
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2208
Practice Address - Country:US
Practice Address - Phone:414-758-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI146336-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse