Provider Demographics
NPI:1184472896
Name:BEAZLEY, ELINORE (PA)
Entity type:Individual
Prefix:MS
First Name:ELINORE
Middle Name:
Last Name:BEAZLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 DAWNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-4709
Mailing Address - Country:US
Mailing Address - Phone:614-327-5767
Mailing Address - Fax:
Practice Address - Street 1:211 E WILSON ST
Practice Address - Street 2:
Practice Address - City:WINGATE
Practice Address - State:NC
Practice Address - Zip Code:28174-9664
Practice Address - Country:US
Practice Address - Phone:704-233-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program