Healthcare Provider Details

I. General information

NPI: 1851548440
Provider Name (Legal Business Name): TRICIA M BEEBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9003 CANYON DR
KENT WA
98030-4779
US

IV. Provider business mailing address

20427 130TH AVE SE
KENT WA
98031
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-1250
  • Fax:
Mailing address:
  • Phone: 206-251-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA60012515
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: