Healthcare Provider Details

I. General information

NPI: 1033464649
Provider Name (Legal Business Name): JENNIE L BEVER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIE L BEVER BABENDURE PHD

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 W LAGUNA AZUL AVE
MESA AZ
85202-6324
US

IV. Provider business mailing address

2629 W LAGUNA AZUL AVE
MESA AZ
85202-6324
US

V. Phone/Fax

Practice location:
  • Phone: 858-442-8266
  • Fax:
Mailing address:
  • Phone: 858-442-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: