Healthcare Provider Details

I. General information

NPI: 1922989367
Provider Name (Legal Business Name): LAUREN BECKMANN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 E MAUMEE ST STE 201
ANGOLA IN
46703-2035
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-667-2700
  • Fax: 260-667-2611
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10005037A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: