Provider Demographics
NPI:1861786857
Name:MCWILLIAMS, BEVERLY A
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 WHISPERING PINES CIR
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8819
Mailing Address - Country:US
Mailing Address - Phone:530-345-0949
Mailing Address - Fax:
Practice Address - Street 1:244 WHISPERING PINES CIR
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:CA
Practice Address - Zip Code:95973-8819
Practice Address - Country:US
Practice Address - Phone:530-345-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN168655164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse