Provider Demographics
NPI:1174951354
Name:BEAVERSTOCK, LINDA (RN, BSN, OBC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:BEAVERSTOCK
Suffix:
Gender:F
Credentials:RN, BSN, OBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 DRESAGE CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4793
Mailing Address - Country:US
Mailing Address - Phone:817-915-8257
Mailing Address - Fax:
Practice Address - Street 1:3512 DRESAGE CT
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4793
Practice Address - Country:US
Practice Address - Phone:817-915-8257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX554742163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant