Provider Demographics
NPI:1881008258
Name:BEAVER, MICHAELA (DNP)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:BEAVER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W CHANDLER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6100
Mailing Address - Country:US
Mailing Address - Phone:480-719-7400
Mailing Address - Fax:480-719-7400
Practice Address - Street 1:3126 S HIGLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2030
Practice Address - Country:US
Practice Address - Phone:520-346-0831
Practice Address - Fax:520-422-5545
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ271946363LF0000X, 363LP0808X
IAA126717363LF0000X
IAG181531363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily