Provider Demographics
NPI:1073719399
Name:BECKWITH, JENNIFER AMBER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:AMBER
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:AMBER
Other - Last Name:MOSBRUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3206 STONEWALL DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5806
Mailing Address - Country:US
Mailing Address - Phone:701-751-0809
Mailing Address - Fax:
Practice Address - Street 1:515 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4407
Practice Address - Country:US
Practice Address - Phone:701-328-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDTRL10257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine