Provider Demographics
NPI:1497203129
Name:BECKER, PAIGE ELIZABETH (RDN)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:BECKER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 SE 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1106
Mailing Address - Country:US
Mailing Address - Phone:412-298-1011
Mailing Address - Fax:
Practice Address - Street 1:636 SE 84TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-1106
Practice Address - Country:US
Practice Address - Phone:412-298-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10185877133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered