Healthcare Provider Details

I. General information

NPI: 1821893819
Provider Name (Legal Business Name): CONNIE LYNNE BECKER CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E BIDDLE ST
JACKSON MI
49203-1800
US

IV. Provider business mailing address

212 E BIDDLE ST
JACKSON MI
49203-1800
US

V. Phone/Fax

Practice location:
  • Phone: 517-783-3434
  • Fax:
Mailing address:
  • Phone: 517-783-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303014271
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number5303014271
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: