Provider Demographics
NPI:1861808057
Name:BEAULIERE, STEPHANIA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:STEPHANIA
Middle Name:
Last Name:BEAULIERE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-823-0739
Mailing Address - Fax:
Practice Address - Street 1:2527 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5708
Practice Address - Country:US
Practice Address - Phone:516-409-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297928164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY297928OtherLPN LICENSE