Healthcare Provider Details

I. General information

NPI: 1275671901
Provider Name (Legal Business Name): DEBRA A BEAUCHAINE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E DUNLAP AVE
PHOENIX AZ
85020-2825
US

IV. Provider business mailing address

250 E DUNLAP AVE
PHOENIX AZ
85020-2825
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-6060
  • Fax: 602-216-5633
Mailing address:
  • Phone: 602-870-6060
  • Fax: 602-216-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP30004269
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP3262
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: