Healthcare Provider Details

I. General information

NPI: 1265403109
Provider Name (Legal Business Name): BRENDA J. BECKETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW CARDIAC SURGERY
WASHINGTON DC
20010-2976
US

IV. Provider business mailing address

5575 SEMINARY RD #14
FALLS CHURCH VA
22041-3553
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-8895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN64763
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: