Basic Information
| Provider Information | |||||||||
| NPI: | 1275671901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEAUCHAINE | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 E DUNLAP AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850202825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028706060 | ||||||||
| FaxNumber: | 6022165633 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 E DUNLAP AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850202825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028706060 | ||||||||
| FaxNumber: | 6022165633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 10/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | AP30004269 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2200X | AP3262 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 0039581 | 01 | WA | LABOR AND INDUSTRIES # | OTHER | 3688BE | 01 | WA | BLUE SHIELD# | OTHER | US7777426 | 01 | WA | AETNA SPECIALIST PIN | OTHER | 9638552 | 05 | WA | MEDICAID |