Healthcare Provider Details

I. General information

NPI: 1164885216
Provider Name (Legal Business Name): CHERYL BEKKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 SOUTH 7650 EAST BOX 9
CROW AGENCY MT
59022-0009
US

IV. Provider business mailing address

PO BOX 207
BIG SANDY MT
59520-0207
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3500
  • Fax:
Mailing address:
  • Phone: 406-399-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28370
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: