Healthcare Provider Details

I. General information

NPI: 1376932509
Provider Name (Legal Business Name): JESSICA EVA BECK CRNA, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA EVA DRAVELING RN

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N15W28300 GOLF RD
PEWAUKEE WI
53072-4800
US

IV. Provider business mailing address

N15W28300 GOLF RD
PEWAUKEE WI
53072-4800
US

V. Phone/Fax

Practice location:
  • Phone: 262-303-5055
  • Fax: 262-303-5057
Mailing address:
  • Phone: 262-303-5055
  • Fax: 262-303-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA 1507
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6949-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number170685-30
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 208279-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: