MEDICARE: JACQUELINE M BECKER NP

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	1010017766	VT
2	363L00000X	Nurse Practitioner	F3335321	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346261054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE M BECKER NP

Provider Business Mailing Address
First Line	:	278 VT ROUTE 149
Second Line	:	METTOWEE VALLEY FAMILY HEALTH CENTER
City	:	WEST PAWLET
State	:	VT
Zip	:	05775-9798
Country	:	US
Telephone Number	:	802-645-0580
Fax Number	:	802-645-0587

Provider Business Practice Location Address
First Line	:	278 VT ROUTE 149
Second Line	:	METTOWEE VALLEY FAMILY HEALTH CENTER
City	:	WEST PAWLET
State	:	VT
Zip	:	05775-9798
Country	:	US
Telephone Number	:	802-645-0580
Fax Number	:	802-645-0587

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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Directions to “ JACQUELINE M BECKER NP” Practice Location

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