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General NPI Number Information
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NPI Number | 1295067411
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Entity Type | Organization
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Legal Business Name | MARY BECKER, LLC
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Dates
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Enumeration Date | 02/13/2010
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 4121 DUTCHMANS LN SUITE 101
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City | LOUISVILLE
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State | KY
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Zip | 40207-4707
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Country | US
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Telephone | 502-896-8660
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Fax | 502-896-5863
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Provider Business Mailing Address
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Address Line | 4121 DUTCHMANS LN SUITE 101
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City | LOUISVILLE
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State | KY
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Zip | 40207-4707
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Country | US
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Telephone | 502-896-8660
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Fax | 502-896-5863
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | KAROLYN SUMSER
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Credential | MBA
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Telephone | 502-896-8660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 2137P
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License Number State | KY
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