MEDICARE: MARY LAUREEN BECTON CROUSE FNP-BC

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	363LF0000X	Family Nurse Practitioner	612543	TX

General Provider Information

NPI Number	:	1841437597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LAUREEN BECTON CROUSE FNP-BC

Provider Business Mailing Address
First Line	:	802 N BONNIE BRAE ST STE 100
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-2417
Country	:	US
Telephone Number	:	940-514-1982
Fax Number	:	940-514-1984

Provider Business Practice Location Address
First Line	:	802 N BONNIE BRAE ST STE 100
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-2417
Country	:	US
Telephone Number	:	940-514-1982
Fax Number	:	940-514-1984

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

Provider Enumeration Date	:	01/17/2009
Last Update Date	:	05/26/2026

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