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General NPI Number Information
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NPI Number | 1063295152
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Entity Type | Individual
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Provider Name | JOANNA BECK PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 3280 E LANARK ST
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City | MERIDIAN
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State | ID
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Zip | 83642-5983
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Country | US
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Telephone | 208-895-8670
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Fax | 208-955-0494
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Provider Business Mailing Address
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Address Line | 10482 W CARLTON BAY DR
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City | GARDEN CITY
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State | ID
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Zip | 83714-5143
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Country | US
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Telephone | 208-955-6500
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Fax | 208-955-6501
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4671984
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License Number State | ID
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