Healthcare Provider Details

I. General information

NPI: 1689726945
Provider Name (Legal Business Name): SCOTT ALFRED BECKER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4828 W SILVER SPRING DR
MILWAUKEE WI
53218-3440
US

IV. Provider business mailing address

127 GLENVIEW AVE
WAUWATOSA WI
53213-3315
US

V. Phone/Fax

Practice location:
  • Phone: 414-535-5826
  • Fax: 414-535-5957
Mailing address:
  • Phone: 414-258-2588
  • Fax: 414-535-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number110464
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: