Provider Demographics
NPI:1770222952
Name:BEAUCHAMP, MARLEE (PA)
Entity Type:Individual
Prefix:
First Name:MARLEE
Middle Name:
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BUFFALO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0373
Mailing Address - Country:US
Mailing Address - Phone:702-242-2737
Mailing Address - Fax:702-255-3170
Practice Address - Street 1:201 N BUFFALO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0373
Practice Address - Country:US
Practice Address - Phone:702-242-2737
Practice Address - Fax:702-255-3170
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2733363AM0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty