Provider Demographics
NPI:1679582654
Name:BECKER, NANCY ANN (DO)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 JEFFERSON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3649
Mailing Address - Country:US
Mailing Address - Phone:360-825-4466
Mailing Address - Fax:360-825-2064
Practice Address - Street 1:1427 JEFFERSON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3649
Practice Address - Country:US
Practice Address - Phone:360-825-4466
Practice Address - Fax:360-825-2064
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001317207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1067636Medicaid
E24691Medicare UPIN
000108851Medicare ID - Type Unspecified