MEDICARE: MR. SCOTT ALFRED BECKER RN

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	163WC0200X	Critical Care Medicine Registered Nurse	110464	WI

General Provider Information

NPI Number	:	1689726945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT ALFRED BECKER RN

Provider Business Mailing Address
First Line	:	127 GLENVIEW AVE
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-3315
Country	:	US
Telephone Number	:	414-258-2588
Fax Number	:	414-535-5957

Provider Business Practice Location Address
First Line	:	4828 W SILVER SPRING DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-3440
Country	:	US
Telephone Number	:	414-535-5826
Fax Number	:	414-535-5957

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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