1992161715 NPI number — MRS. BECCA SUZANNE NEWBERRY FNP

Table of content: MRS. BECCA SUZANNE NEWBERRY FNP (NPI 1992161715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992161715 NPI number — MRS. BECCA SUZANNE NEWBERRY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWBERRY
Provider First Name:
BECCA
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEWBERRY
Provider Other First Name:
BECKY
Provider Other Middle Name:
SUZANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1992161715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40413 N GRAHAM WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANTHEM
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85086-1884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-229-7054
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14010 N NORTHSIGHT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-443-0384
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2016

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: 363LF0000X , with the licence number:  AP8371 , 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)