Provider Demographics
NPI:1629067756
Name:HOWARD, BECKY JANE
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:JANE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:JANE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-686-9000
Mailing Address - Fax:541-242-4585
Practice Address - Street 1:2380 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7397
Practice Address - Country:US
Practice Address - Phone:541-686-9000
Practice Address - Fax:541-242-4585
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201392023NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629067756OtherNPI
OR500663537Medicaid
1629067756OtherNPI