Healthcare Provider Details

I. General information

NPI: 1174240071
Provider Name (Legal Business Name): MEGAN BEFORT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7302 N 10TH ST
PHOENIX AZ
85020-5327
US

IV. Provider business mailing address

6804 N 11TH ST
PHOENIX AZ
85014-1057
US

V. Phone/Fax

Practice location:
  • Phone: 602-664-7322
  • Fax:
Mailing address:
  • Phone: 623-570-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN180410
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: