Provider Demographics
NPI:1487134045
Name:ALBANESE, BEAU (PMHNP)
Entity type:Individual
Prefix:DR
First Name:BEAU
Middle Name:
Last Name:ALBANESE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86TH MEDICAL GROUP
Mailing Address - Street 2:
Mailing Address - City:RAMSTEIN AB
Mailing Address - State:GERMANY
Mailing Address - Zip Code:09094
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86TH MEDICAL GROUP
Practice Address - Street 2:
Practice Address - City:RAMSTEIN AB
Practice Address - State:GERMANY
Practice Address - Zip Code:09094
Practice Address - Country:DE
Practice Address - Phone:719-479-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902684363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health