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General NPI Number Information
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NPI Number | 1508040023
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Entity Type | Individual
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Provider Name | CORLENE ALETA BECKER RN
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Gender | Female
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 2301 KRIER RD
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City | GENESEE
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State | ID
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Zip | 83832
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Country | US
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Telephone | 208-285-1178
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 417
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City | GENESEE
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State | ID
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Zip | 83832
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Country | US
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Telephone | 208-285-1178
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | N-16760
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License Number State | ID
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