Healthcare Provider Details

I. General information

NPI: 1164490959
Provider Name (Legal Business Name): ALICE A BECKMAN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2893 NEIL AVE APT. 400-B
COLUMBUS OH
43202-2047
US

IV. Provider business mailing address

2893 NEIL AVE APT. 400-B
COLUMBUS OH
43202-2047
US

V. Phone/Fax

Practice location:
  • Phone: 651-323-7781
  • Fax:
Mailing address:
  • Phone: 651-323-7781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberR127675-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: