Healthcare Provider Details

I. General information

NPI: 1548325327
Provider Name (Legal Business Name): WENDY M BECKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N WATER ST
WATERTOWN WI
53094-7683
US

IV. Provider business mailing address

515 ISLAND VIEW CIR
HUSTISFORD WI
53034-9706
US

V. Phone/Fax

Practice location:
  • Phone: 262-224-6277
  • Fax:
Mailing address:
  • Phone: 262-224-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: