Provider Demographics
NPI:1790547693
Name:MARRERO, BEDA DIANA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:BEDA
Middle Name:DIANA
Last Name:MARRERO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 SUNNY HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6880
Mailing Address - Country:US
Mailing Address - Phone:805-758-2277
Mailing Address - Fax:
Practice Address - Street 1:1111 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4118
Practice Address - Country:US
Practice Address - Phone:509-897-3700
Practice Address - Fax:509-897-8589
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61521106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily