Provider Demographics
NPI:1992865737
Name:ANDRESEN, BETH ISMARK (WHNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ISMARK
Last Name:ANDRESEN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:ISMARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3838 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1454
Mailing Address - Country:US
Mailing Address - Phone:520-694-8888
Mailing Address - Fax:
Practice Address - Street 1:1871 WEST ORANGE GROVE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-498-5000
Practice Address - Fax:520-498-5011
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ077679363LW0102X
AZRN077619363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ367723Medicaid
Z122354Medicare PIN
AZS82053Medicare UPIN