Healthcare Provider Details

I. General information

NPI: 1811048739
Provider Name (Legal Business Name): B J BECKERRN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6283 RIESCH RD
WEST BEND WI
53095-9106
US

IV. Provider business mailing address

6283 RIESCH RD
WEST BEND WI
53095-9106
US

V. Phone/Fax

Practice location:
  • Phone: 262-334-1021
  • Fax: 262-334-0556
Mailing address:
  • Phone: 262-334-1021
  • Fax: 262-334-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number39979100
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: