Provider Demographics
NPI:1275671901
Name:BEAUCHAINE, DEBRA A (ANP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:BEAUCHAINE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E DUNLAP AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2825
Mailing Address - Country:US
Mailing Address - Phone:602-870-6060
Mailing Address - Fax:602-216-5633
Practice Address - Street 1:250 E DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2825
Practice Address - Country:US
Practice Address - Phone:602-870-6060
Practice Address - Fax:602-216-5633
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004269363LG0600X
AZAP3262363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039581OtherLABOR AND INDUSTRIES #
WA3688BEOtherBLUE SHIELD#
WAUS7777426OtherAETNA SPECIALIST PIN
WA9638552Medicaid
WA3688BEOtherBLUE SHIELD#
AB34662Medicare ID - Type Unspecified
WAUS7777426OtherAETNA SPECIALIST PIN