Healthcare Provider Details

I. General information

NPI: 1366420739
Provider Name (Legal Business Name): JACQUELINE BECKWITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37400 BELL ST
SANDY OR
97055-7868
US

IV. Provider business mailing address

2051 KAEN RD STE 367
OREGON CITY OR
97045-4035
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-3483
  • Fax: 503-668-1892
Mailing address:
  • Phone: 503-742-5300
  • Fax: 503-742-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200650004NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: