Provider Demographics
NPI:1558481986
Name:VAN BUREN, BECKY (FNP)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:VAN BUREN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 N ALMA SCHOOL RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5901
Mailing Address - Country:US
Mailing Address - Phone:480-963-1853
Mailing Address - Fax:480-963-1854
Practice Address - Street 1:4136 N 75TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-3171
Practice Address - Country:US
Practice Address - Phone:623-849-2220
Practice Address - Fax:623-849-2574
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ074771163WS0200X
AZAP3400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP3400OtherAZ BOARD OF NURSING
AZ623480Medicaid