Provider Demographics
NPI:1235465501
Name:DUBE, BEATRICE K
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:K
Last Name:DUBE
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 1:9589 FOUR WINDS DR
Mailing Address - Street 2:#712
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7134
Mailing Address - Country:US
Mailing Address - Phone:916-897-8812
Mailing Address - Fax:
Practice Address - Street 1:1900 T ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-6822
Practice Address - Country:US
Practice Address - Phone:916-558-4800
Practice Address - Fax:916-558-4806
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 14195363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology