Provider Demographics
NPI:1154682789
Name:BEKE, DOROTHY M (RN, MS, CPNP-PC/AC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:M
Last Name:BEKE
Suffix:
Gender:F
Credentials:RN, MS, CPNP-PC/AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-7006
Mailing Address - Country:US
Mailing Address - Phone:781-381-2556
Mailing Address - Fax:
Practice Address - Street 1:120 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-7006
Practice Address - Country:US
Practice Address - Phone:781-381-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN172297363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics