Provider Demographics
NPI:1619960382
Name:BECKER, ANNE BREEN
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:BREEN
Last Name:BECKER
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 1:420 HOWANUT RD
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98568-9616
Mailing Address - Country:US
Mailing Address - Phone:360-273-5504
Mailing Address - Fax:360-273-6230
Practice Address - Street 1:420 HOWANUT RD
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:WA
Practice Address - Zip Code:98568-9616
Practice Address - Country:US
Practice Address - Phone:360-273-5504
Practice Address - Fax:360-273-6230
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY8200776Medicaid