Provider Demographics
NPI:1619557410
Name:BECKHAM, STEPHANIE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BECKHAM
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 E SADDLEBACK LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4683
Mailing Address - Country:US
Mailing Address - Phone:503-396-2418
Mailing Address - Fax:
Practice Address - Street 1:914 E SADDLEBACK LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4683
Practice Address - Country:US
Practice Address - Phone:503-396-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60942232163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice