MEDICARE: BECKY VAN BUREN FNP

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	163WS0200X	School Registered Nurse	074771	AZ
2	363LF0000X	Family Nurse Practitioner	AP3400	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP3400	OTHER	AZ	AZ BOARD OF NURSING
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558481986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY VAN BUREN FNP

Provider Business Mailing Address
First Line	:	1343 N ALMA SCHOOL RD
Second Line	:	STE 160
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5901
Country	:	US
Telephone Number	:	480-963-1853
Fax Number	:	480-963-1854

Provider Business Practice Location Address
First Line	:	4136 N 75TH AVE
Second Line	:	STE 101
City	:	PHOENIX
State	:	AZ
Zip	:	85033-3171
Country	:	US
Telephone Number	:	623-849-2220
Fax Number	:	623-849-2574

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	09/07/2016

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