Healthcare Provider Details

I. General information

NPI: 1578167607
Provider Name (Legal Business Name): BECKI EWY CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W GUADALUPE RD
MESA AZ
85202-7575
US

IV. Provider business mailing address

1501 W GUADALUPE RD
MESA AZ
85202-7575
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-3027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number247097
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number247097
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: