Provider Demographics
NPI:1063041119
Name:BECK, STEPHANIE ERIN (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ERIN
Last Name:BECK
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20567 BIRCH CREST LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-6822
Mailing Address - Country:US
Mailing Address - Phone:765-860-6339
Mailing Address - Fax:
Practice Address - Street 1:20567 BIRCH CREST LN
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-6822
Practice Address - Country:US
Practice Address - Phone:765-860-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018742363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics