Healthcare Provider Details

I. General information

NPI: 1346261054
Provider Name (Legal Business Name): JACQUELINE M BECKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 VT ROUTE 149 METTOWEE VALLEY FAMILY HEALTH CENTER
WEST PAWLET VT
05775-9798
US

IV. Provider business mailing address

278 VT ROUTE 149 METTOWEE VALLEY FAMILY HEALTH CENTER
WEST PAWLET VT
05775-9798
US

V. Phone/Fax

Practice location:
  • Phone: 802-645-0580
  • Fax: 802-645-0587
Mailing address:
  • Phone: 802-645-0580
  • Fax: 802-645-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1010017766
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF3335321
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: