Healthcare Provider Details

I. General information

NPI: 1538709761
Provider Name (Legal Business Name): SHANA J BEAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W APACHE TRL STE 4
APACHE JUNCTION AZ
85120-3963
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 480-870-7130
  • Fax: 480-870-7132
Mailing address:
  • Phone: 615-315-5257
  • Fax: 615-692-0547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236126
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: