Healthcare Provider Details

I. General information

NPI: 1427326974
Provider Name (Legal Business Name): SHERRILL JUNE BECKER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14784 STATE HIGHWAY 30
DOWNSVILLE NY
13755
US

IV. Provider business mailing address

14784 STATE HIGHWAY 30 PO BOX J
DOWNSVILLE NY
13755
US

V. Phone/Fax

Practice location:
  • Phone: 607-363-2120
  • Fax:
Mailing address:
  • Phone: 607-363-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number378092-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: