Provider Demographics
NPI:1629075643
Name:MCINTYRE, VICKI BEALL (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:BEALL
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 W FAIRVIEW ST STE 9
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4711
Mailing Address - Country:US
Mailing Address - Phone:480-470-4000
Mailing Address - Fax:520-327-3431
Practice Address - Street 1:899 N WILMOT RD STE E4
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1783
Practice Address - Country:US
Practice Address - Phone:480-686-8874
Practice Address - Fax:486-868-8875
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN054523163WG0100X
AZFNP-AP1424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ68256Medicare ID - Type Unspecified
AZP47323Medicare UPIN