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General NPI Number Information
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NPI Number | 1346493806
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Entity Type | Organization
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Legal Business Name | EAR NOSE THROAT FACIAL PLASTIC SURGERY AND ALLERGY OF WESTERN WA
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 1427 JEFFERSON AVE
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City | ENUMCLAW
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State | WA
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Zip | 98022-3613
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Country | US
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Telephone | 360-825-4466
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Fax | 360-825-2064
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Provider Business Mailing Address
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Address Line | 1427 JEFFERSON AVE STE 101
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City | ENUMCLAW
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State | WA
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Zip | 98022-3649
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Country | US
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Telephone | 360-825-4466
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Fax | 360-825-2064
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NANCY A BECKER
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Credential | DO
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Telephone | 360-825-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | OP00001317
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License Number State | WA
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