Healthcare Provider Details

I. General information

NPI: 1386737351
Provider Name (Legal Business Name): DEBRA L BECK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 DORBETT ST
JASPER IN
47546
US

IV. Provider business mailing address

613 DORBETT ST
JASPER IN
47546
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-1289
  • Fax: 812-482-3993
Mailing address:
  • Phone: 812-482-1289
  • Fax: 812-482-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28078546A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: