Healthcare Provider Details

I. General information

NPI: 1972162691
Provider Name (Legal Business Name): MELISSA ANN BECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W MICHIGAN AVE
JACKSON MI
49201-1345
US

IV. Provider business mailing address

180 W MICHIGAN AVE
JACKSON MI
49201-1345
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-5710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703113622
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: