Provider Demographics
NPI:1487238291
Name:ST. AMOUR, BEVERLY JEANETTE
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JEANETTE
Last Name:ST. AMOUR
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 1:3520 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3631
Mailing Address - Country:US
Mailing Address - Phone:734-642-6331
Mailing Address - Fax:
Practice Address - Street 1:3520 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-3631
Practice Address - Country:US
Practice Address - Phone:734-642-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIS535085385072363LA2100X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care