Basic Information
| Provider Information | |||||||||
| NPI: | 1447445408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEACHY | ||||||||
| FirstName: | EUNICE | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19500 10TH AVE NE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983706331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605987500 | ||||||||
| FaxNumber: | 3605987505 | ||||||||
| Practice Location | |||||||||
| Address1: | 19500 10TH AVE NE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | POULSBOE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983706331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535987500 | ||||||||
| FaxNumber: | 2535987505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2007 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AP30007843 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 2005138 | 05 | WA | MEDICAID |