Individual
CORLENE ALETA BECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2301 KRIER RD, GENESEE, ID 83832
(208) 285-1178
Mailing address
PO BOX 417, GENESEE, ID 83832
(208) 285-1178
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
N-16760
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805589100
—
ID
Enumeration date
12/19/2007
Last updated
12/19/2007
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