MEDICARE: MARSHA BEYDOUN PMHNP BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP2806	AZ

General Provider Information

NPI Number	:	1407031107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA BEYDOUN PMHNP BC

Provider Business Mailing Address
First Line	:	PO BOX 11783
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85318-1783
Country	:	US
Telephone Number	:	623-224-9116
Fax Number	:

Provider Business Practice Location Address
First Line	:	19801 N 59TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6801
Country	:	US
Telephone Number	:	623-224-9116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	08/07/2014

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