Provider Demographics
NPI:1912647405
Name:BEVHION BOUDICA FAMILY HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:BEVHION BOUDICA FAMILY HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVHION
Authorized Official - Middle Name:BEATRIX
Authorized Official - Last Name:BOUDICA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:928-863-6673
Mailing Address - Street 1:2323 E GREENLAW LN STE 7B
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1849
Mailing Address - Country:US
Mailing Address - Phone:928-863-6673
Mailing Address - Fax:928-222-2285
Practice Address - Street 1:2323 E GREENLAW LN STE 7B
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1849
Practice Address - Country:US
Practice Address - Phone:928-863-6673
Practice Address - Fax:928-222-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care