Provider Demographics
NPI:1821276452
Name:MIKUS, BEVERLY LYNDELE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:LYNDELE
Last Name:MIKUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:BEVERLY
Other - Middle Name:LYNDELE
Other - Last Name:BONNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3950 S COUNTRY CLUB RD
Mailing Address - Street 2:STE 400
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714
Mailing Address - Country:US
Mailing Address - Phone:520-243-8000
Mailing Address - Fax:520-243-8311
Practice Address - Street 1:410 MALACATE ST
Practice Address - Street 2:
Practice Address - City:AJO
Practice Address - State:AZ
Practice Address - Zip Code:85321
Practice Address - Country:US
Practice Address - Phone:520-738-7703
Practice Address - Fax:520-387-6036
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN064885163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health