Provider Demographics
NPI:1093196438
Name:BECKMANN, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BECKMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 SUZANNE WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7619
Mailing Address - Country:US
Mailing Address - Phone:541-228-3020
Mailing Address - Fax:541-228-3181
Practice Address - Street 1:2650 SUZANNE WAY STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7619
Practice Address - Country:US
Practice Address - Phone:541-228-3020
Practice Address - Fax:541-228-3181
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1081723133V00000X
ORLD-D1064029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered