MEDICARE: BEENA MATHEW NP

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	363LF0000X	Family Nurse Practitioner	274604	AZ

General Provider Information

NPI Number	:	1285354449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEENA MATHEW NP

Provider Business Mailing Address
First Line	:	2426 W MAYA WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-5789
Country	:	US
Telephone Number	:	623-308-6556
Fax Number	:

Provider Business Practice Location Address
First Line	:	2426 W MAYA WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-5789
Country	:	US
Telephone Number	:	623-308-6556
Fax Number	:

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

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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