Healthcare Provider Details

I. General information

NPI: 1093196438
Provider Name (Legal Business Name): TRACY BECKMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 SUZANNE WAY STE 200
EUGENE OR
97408-7619
US

IV. Provider business mailing address

2650 SUZANNE WAY STE 200
EUGENE OR
97408-7619
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-3020
  • Fax: 541-228-3181
Mailing address:
  • Phone: 541-228-3020
  • Fax: 541-228-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1081723
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D1064029
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: