MEDICARE: MRS. LAURIE ANNE BECK RN,MSN,IBCLC, RLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	100-16210	NC
2	163WL0100X	Lactation Consultant (Registered Nurse)	521876	TX

General Provider Information

NPI Number	:	1124234125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE ANNE BECK RN,MSN,IBCLC, RLC

Provider Business Mailing Address
First Line	:	2214 GERSHWIN LN
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-2765
Country	:	US
Telephone Number	:	361-994-8944
Fax Number	:

Provider Business Practice Location Address
First Line	:	2214 GERSHWIN LN
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-2765
Country	:	US
Telephone Number	:	361-994-8944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	10/16/2009

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