Provider Demographics
NPI:1073577490
Name:THOMAS-BECKETT, JULIE G (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:G
Last Name:THOMAS-BECKETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD STE A202
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-355-2822
Mailing Address - Fax:517-355-2824
Practice Address - Street 1:804 SERVICE RD STE A110
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7015
Practice Address - Country:US
Practice Address - Phone:517-355-2822
Practice Address - Fax:517-355-2824
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704160542363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N55170012OtherMEDICARE ADVANTAGE
MI200000006543OtherPHP
MI9340263OtherAETNA
MI200000006543OtherPHP FAMILYCARE
MI4634529Medicaid
MI5008703640OtherBLUE CROSS BLUE SHIELD
MI1059823OtherMCLAREN HEALTH PLAN-COMMERCIAL
MIP00473882OtherRAILROAD MEDICARE
MI1059823OtherMCLAREN HEALTH ADVANTAGE
MI1059823OtherMCLAREN HEALTH PLAN-MEDICAID
MI1059823OtherMCLAREN HEALTH PLAN-MEDICAID
MI200000006543OtherPHP FAMILYCARE