MEDICARE: JESSICA LYNN BECKMANN RD, CNSC

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	133VN1004X	Pediatric Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1356899728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNN BECKMANN RD, CNSC

Provider Business Mailing Address
First Line	:	1580 MADISON ST
Second Line	:	APT 105
City	:	OAKLAND
State	:	CA
Zip	:	94612-4556
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1580 MADISON ST
Second Line	:	APT 105
City	:	OAKLAND
State	:	CA
Zip	:	94612-4556
Country	:	US
Telephone Number	:	970-593-2652
Fax Number	:

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

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	09/14/2016

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