Carline Beck
Individual provider Active NPI Specialist · Centralia, WA
NPI 1104254358 · NPPES record last updated Oct 25, 2013
Key facts
- NPI
- 1104254358
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- MA1146 (WA)
- Practice address
- 1326 Windsor Ave
Centralia, WA 98531-5332 - Phone
- (360) 736-6987
- NPI assigned
- Oct 25, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA1146 | WA | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA1146 | WA | Yes |
Addresses
Primary practice location
1326 Windsor Ave
Centralia, WA 98531-5332
Mailing address
1326 Windsor Ave.
Centralia, WA 98531
Phone (360) 736-6987
Other providers in Centralia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.