Healthcare Provider Details

I. General information

NPI: 1720112998
Provider Name (Legal Business Name): LORI ANN BECKER I R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 3RD AVE
WAYLAND NY
14572-1232
US

IV. Provider business mailing address

11034 PFAFF HOLLOW RD
WAYLAND NY
14572-9528
US

V. Phone/Fax

Practice location:
  • Phone: 585-728-5743
  • Fax:
Mailing address:
  • Phone: 585-213-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number399391-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: