=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639671928
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEAH RAE HAAK BECK PA-C, RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2018
-----------------------------------------------------
Last Update Date | 08/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 N 27TH ST
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68701-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-844-8680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 N 27TH ST
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68701-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-844-8680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 1229957
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | DI60614169
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------