Provider Demographics
NPI:1073911780
Name:BECK, KRISTA (LPN)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 CASE PKWY
Mailing Address - Street 2:# 10 PO BOX468
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-4301
Mailing Address - Country:US
Mailing Address - Phone:330-425-2905
Mailing Address - Fax:866-687-2823
Practice Address - Street 1:2112 CASE PKWY
Practice Address - Street 2:# 10
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-4301
Practice Address - Country:US
Practice Address - Phone:330-425-2905
Practice Address - Fax:866-687-2823
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN064356164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse