Healthcare Provider Details

I. General information

NPI: 1790768943
Provider Name (Legal Business Name): LISA H BECK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 VIRGINIA AVE
NARROWS VA
24124-2369
US

IV. Provider business mailing address

606 OWENS ST
BLACKSBURG VA
24060-7223
US

V. Phone/Fax

Practice location:
  • Phone: 540-726-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-840666
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: