Healthcare Provider Details

I. General information

NPI: 1134267248
Provider Name (Legal Business Name): BECKY L SPEAR R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 FRONT ST
FAIRBANKS AK
99701-3145
US

IV. Provider business mailing address

222 FRONT ST
FAIRBANKS AK
99701-3145
US

V. Phone/Fax

Practice location:
  • Phone: 907-451-7100
  • Fax: 907-451-7168
Mailing address:
  • Phone: 907-451-7100
  • Fax: 907-451-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberNUR R 4025
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: