Healthcare Provider Details

I. General information

NPI: 1093081739
Provider Name (Legal Business Name): JENNIFER ANNE BECKERING RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CHANTICLEER CIRCLE
NEW STANTON PA
15672
US

IV. Provider business mailing address

300 CHANTICLEER CIRCLE
NEW STANTON PA
15672
US

V. Phone/Fax

Practice location:
  • Phone: 607-221-7839
  • Fax:
Mailing address:
  • Phone: 607-221-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number619664-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN623447
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: