=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235113085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH H BECKHAM RN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2005
-----------------------------------------------------
Last Update Date | 08/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9005 GRANT ST #200
-----------------------------------------------------
City | THORNTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80229-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-287-2800
-----------------------------------------------------
Fax | 303-287-7357
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9005 GRANT ST #200
-----------------------------------------------------
City | THORNTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80229-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-287-2800
-----------------------------------------------------
Fax | 303-287-7357
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 63736
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------