MEDICARE: MS. BECCA KREBS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1649507625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BECCA KREBS

Provider Business Mailing Address
First Line	:	780 SUZANNE AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-1298
Country	:	US
Telephone Number	:	575-526-1820
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 SUZANNE AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-1298
Country	:	US
Telephone Number	:	575-526-1820
Fax Number	:

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

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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