Individual provider · Type 1 NPI

Beverly J. Provo, GNPC

Family Nurse Practitioner · Newark, NY

NPI number 1215096482 Active

Practice location

1208 Driving Park Ave
Newark, NY 14513-1057

Specialties and licenses

TaxonomyCodeLicense
Adult Health Nurse Practitioner 363LA2200XF3041711 (NY)
Family Nurse Practitioner Primary 363LF0000XF3403661 (NY)

Family Nurse Practitioner: Definition to come...

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About NPI 1215096482

Beverly J. Provo, GNPC's National Provider Identifier is 1215096482, issued on Dec 6, 2006. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Newark, NY. The record was last updated on Jan 6, 2011.