Healthcare Provider Details

I. General information

NPI: 1346761509
Provider Name (Legal Business Name): DAPHNE JEAN BECK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E. FOURTH PLAIN BLVD BLG 17 3RD FLOOR
VANCOUVER WA
98661
US

IV. Provider business mailing address

PO BOX 9825
VANCOUVER WA
98666-8825
US

V. Phone/Fax

Practice location:
  • Phone: 360-518-2212
  • Fax:
Mailing address:
  • Phone: 360-397-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberRN00063164
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00063164
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN00063164
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: