Healthcare Provider Details

I. General information

NPI: 1265533764
Provider Name (Legal Business Name): SUSAN ELLEN BECK C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 GREENWOOD AVE
JACKSON MI
49203-3077
US

IV. Provider business mailing address

1310 GREENWOOD AVE
JACKSON MI
49203-3077
US

V. Phone/Fax

Practice location:
  • Phone: 517-962-0123
  • Fax: 517-201-8067
Mailing address:
  • Phone: 517-962-0123
  • Fax: 517-201-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704219112
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: