Most Relevant Information
Provider Data
| NPI Number: | 1003399759 |
| Provider Name: | BEVERLY J SHAMLOO NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 71008290A |
Most Important Dates
| Enumeration Date: | 09/10/2018 |
| Last Updated: | 06/02/2020 |
Provider Practice Location
1520 S LIBERTY DR
BLOOMINGTON
IN
474035167
Practice Location Phone/Fax
| Phone: | 8126764500 |
| Fax: |
Provider Mailing Location
1520 S LIBERTY DR
BLOOMINGTON
IN
474035167
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |