MEDICARE: LAWRENCE RAYMOND BEEK III RN, N.P.

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	4704276628	MI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704276628	MI

General Provider Information

NPI Number	:	1780938969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE RAYMOND BEEK III RN, N.P.

Provider Business Mailing Address
First Line	:	1001 MULHOLLAND ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7646
Country	:	US
Telephone Number	:	989-391-9900
Fax Number	:	989-497-1530

Provider Business Practice Location Address
First Line	:	1001 MULHOLLAND ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7646
Country	:	US
Telephone Number	:	989-391-9900
Fax Number	:	989-497-1530

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

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	11/29/2012

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