Healthcare Provider Details

I. General information

NPI: 1992783666
Provider Name (Legal Business Name): STEPHANIE R BECKER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WALKER AVE
BALTIMORE MD
21208-4004
US

IV. Provider business mailing address

2520 SUMMERSON RD
BALTIMORE MD
21209-2516
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-6800
  • Fax: 410-484-6534
Mailing address:
  • Phone: 410-484-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR088031
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: