Provider Demographics
NPI:1154022077
Name:BECKER, JENNY REBECCA (RN)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:REBECCA
Last Name:BECKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:REBECCA
Other - Last Name:VIRDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 ANDOVER PARK W STE 107
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3911
Mailing Address - Country:US
Mailing Address - Phone:253-533-8019
Mailing Address - Fax:
Practice Address - Street 1:1101 ANDOVER PARK W STE 107
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3911
Practice Address - Country:US
Practice Address - Phone:253-533-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60156611163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse