1275671901 NPI number — DEBRA A BEAUCHAINE ANP

Table of content: DEBRA A BEAUCHAINE ANP (NPI 1275671901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275671901 NPI number — DEBRA A BEAUCHAINE ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEAUCHAINE
Provider First Name:
DEBRA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275671901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 E DUNLAP AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85020-2825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-870-6060
Provider Business Mailing Address Fax Number:
602-216-5633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 E DUNLAP AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85020-2825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-870-6060
Provider Business Practice Location Address Fax Number:
602-216-5633
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  AP30004269 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: AP3262 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0039581 . This is a "LABOR AND INDUSTRIES #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3688BE . This is a "BLUE SHIELD#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: US7777426 . This is a "AETNA SPECIALIST PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9638552 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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