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General NPI Number Information
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NPI Number | 1194146647
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Entity Type | Individual
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Provider Name | BECKY WALTZ LMP
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Gender | Female
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Dates
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Enumeration Date | 12/31/2013
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 8401 MAIN ST
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City | EDMONDS
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State | WA
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Zip | 98026-6919
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Country | US
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Telephone | 425-563-6893
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Fax |
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Provider Business Mailing Address
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Address Line | 9889 CENTRAL VALLEY RD NW
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City | BREMERTON
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State | WA
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Zip | 98311-9131
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Country | US
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Telephone |
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Fax | 360-629-1718
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA60407123
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License Number State | WI
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