1174915839 NPI number — MRS. ELIZABETH BEAVER WHNP-BC

Table of content: MRS. ELIZABETH BEAVER WHNP-BC (NPI 1174915839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174915839 NPI number — MRS. ELIZABETH BEAVER WHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEAVER
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
WHNP-BC
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:
1174915839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
655 S. DOBSON RD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-459-2555
Provider Business Mailing Address Fax Number:
480-687-1802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 S. DOBSON RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-782-0993
Provider Business Practice Location Address Fax Number:
855-329-8939
Provider Enumeration Date:
03/04/2015

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: 363LW0102X , with the licence number:  AP7665 , 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: 421989 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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