Healthcare Provider Details

I. General information

NPI: 1073577490
Provider Name (Legal Business Name): JULIE G THOMAS-BECKETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 09/11/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 SERVICE RD STE A110
EAST LANSING MI
48824-7015
US

IV. Provider business mailing address

804 SERVICE RD STE A202
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-355-2822
  • Fax: 517-355-2824
Mailing address:
  • Phone: 517-355-2822
  • Fax: 517-355-2824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704160542
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: