Provider Demographics
NPI:1003147695
Name:KING, BETH L (RN, CDE)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2077
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:503-413-3710
Practice Address - Street 1:2101 NE 139TH ST
Practice Address - Street 2:SUITE 460
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2309
Practice Address - Country:US
Practice Address - Phone:360-487-2727
Practice Address - Fax:360-487-2729
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00065069163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPENDINGMedicare UPIN