Provider Demographics
NPI:1033464649
Name:BEVER, JENNIE L (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:L
Last Name:BEVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENNIE
Other - Middle Name:L
Other - Last Name:BEVER BABENDURE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2629 W LAGUNA AZUL AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6324
Mailing Address - Country:US
Mailing Address - Phone:858-442-8266
Mailing Address - Fax:
Practice Address - Street 1:2629 W LAGUNA AZUL AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6324
Practice Address - Country:US
Practice Address - Phone:858-442-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN