Healthcare Provider Details

I. General information

NPI: 1821276452
Provider Name (Legal Business Name): BEVERLY LYNDELE MIKUS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BEVERLY LYNDELE BONNEY RN

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MALACATE ST
AJO AZ
85321
US

IV. Provider business mailing address

3950 S COUNTRY CLUB RD STE 400
TUCSON AZ
85714
US

V. Phone/Fax

Practice location:
  • Phone: 520-738-7703
  • Fax: 520-387-6036
Mailing address:
  • Phone: 520-243-8000
  • Fax: 520-243-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN064885
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: