Provider Demographics
NPI:1629010616
Name:BEACH, IRENE K (CNM)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:K
Last Name:BEACH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:M
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 NE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1913
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:360-604-1771
Practice Address - Street 1:2525 NE 139TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2719
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1762
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000040132N5367A00000X
OR000040132RN367A00000X
WARN00076406367A00000X
WAAP30003921367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife