Healthcare Provider Details

I. General information

NPI: 1174915839
Provider Name (Legal Business Name): ELIZABETH BEAVER WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S. DOBSON RD STE 101
CHANDLER AZ
85224
US

IV. Provider business mailing address

655 S. DOBSON RD STE 101
CHANDLER AZ
85224
US

V. Phone/Fax

Practice location:
  • Phone: 480-782-0993
  • Fax: 855-329-8939
Mailing address:
  • Phone: 480-459-2555
  • Fax: 480-687-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP7665
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: