=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447255575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARCIA LYNN BECKLEY FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2005
-----------------------------------------------------
Last Update Date | 03/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1780 HANSHAW RD
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850-9105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-257-5858
-----------------------------------------------------
Fax | 607-257-1718
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 GUTHRIE SQ
-----------------------------------------------------
City | SAYRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18840-1699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-888-5858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0000X
-----------------------------------------------------
Taxonomy Name | General Practice Registered Nurse
-----------------------------------------------------
License Number | 5353206
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F333164
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------