MEDICARE: ANGELA DENISE BEAUCHAMP PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	PA60769549	WA
2	363A00000X	Physician Assistant	PA60769549	WA

General Provider Information

NPI Number	:	1275053514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DENISE BEAUCHAMP PA

Provider Business Mailing Address
First Line	:	PO BOX 421
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0421
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:	509-227-7070

Provider Business Practice Location Address
First Line	:	1402 S GRAND BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-5001
Country	:	US
Telephone Number	:	509-455-8220
Fax Number	:	509-455-9172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	04/16/2021

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