MEDICARE: DAVID BECKER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704269668	MI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704269668	MI

General Provider Information

NPI Number	:	1336183276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BECKER APRN

Provider Business Mailing Address
First Line	:	411 COLLEGE AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-5301
Country	:	US
Telephone Number	:	860-608-5848
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 MOON LAKE BLVD
Second Line	:	ST.E 150
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1069
Country	:	US
Telephone Number	:	847-519-3651
Fax Number	:	847-519-3652

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	12/11/2024

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