Healthcare Provider Details

I. General information

NPI: 1619960382
Provider Name (Legal Business Name): ANNE BREEN BECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 HOWANUT RD
OAKVILLE WA
98568-9616
US

IV. Provider business mailing address

420 HOWANUT RD
OAKVILLE WA
98568-9616
US

V. Phone/Fax

Practice location:
  • Phone: 360-273-5504
  • Fax: 360-273-6230
Mailing address:
  • Phone: 360-273-5504
  • Fax: 360-273-6230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30001568
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: