Provider Demographics
NPI:1194817981
Name:BECKER, GEORGE (CRNA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BECKER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 GLENMARY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2103
Mailing Address - Country:US
Mailing Address - Phone:502-767-7553
Mailing Address - Fax:502-451-1131
Practice Address - Street 1:2418 GLENMARY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-2103
Practice Address - Country:US
Practice Address - Phone:502-767-7553
Practice Address - Fax:502-451-1131
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1039257367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered