Healthcare Provider Details

I. General information

NPI: 1275059214
Provider Name (Legal Business Name): DENISE RAE BECKLER REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 GWINNETT DR
LAWRENCEVILLE GA
30046-8444
US

IV. Provider business mailing address

755 COLEEN DR
WINDER GA
30680-7202
US

V. Phone/Fax

Practice location:
  • Phone: 678-209-2411
  • Fax: 678-209-2411
Mailing address:
  • Phone: 701-260-0971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN262385
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: