Provider Demographics
NPI:1821234428
Name:BECK, VICKI DIANE (RNFA)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:DIANE
Last Name:BECK
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:D
Other - Last Name:BEVANDICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1524 NW JONQUIL PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3637
Mailing Address - Country:US
Mailing Address - Phone:541-768-6770
Mailing Address - Fax:541-768-6774
Practice Address - Street 1:3600 NW SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3737
Practice Address - Country:US
Practice Address - Phone:541-768-6770
Practice Address - Fax:541-768-6774
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR076036530RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant