Healthcare Provider Details

I. General information

NPI: 1447255575
Provider Name (Legal Business Name): MARCIA LYNN BECKLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/04/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 HANSHAW RD
ITHACA NY
14850-9105
US

IV. Provider business mailing address

1 GUTHRIE SQ
SAYRE PA
18840-1699
US

V. Phone/Fax

Practice location:
  • Phone: 607-257-5858
  • Fax: 607-257-1718
Mailing address:
  • Phone: 570-888-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF333164
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number5353206
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: