Healthcare Provider Details

I. General information

NPI: 1104663905
Provider Name (Legal Business Name): DEBORAH JEAN BECKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH JEAN EARLE

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

IV. Provider business mailing address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-3435
  • Fax:
Mailing address:
  • Phone: 402-995-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number56224
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: