Provider Demographics
NPI:1225148612
Name:BECKER, CAROL ANN (MSN, APRN, BC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 CRESTRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3934
Mailing Address - Country:US
Mailing Address - Phone:970-494-9761
Mailing Address - Fax:
Practice Address - Street 1:525 W OAK ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2612
Practice Address - Country:US
Practice Address - Phone:970-494-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19275.0810363LP0808X, 364SP0808X
CORN.0081501363L00000X
COAPN.0991227-NP363L00000X
CORXN.0101019-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312357OtherBS OF WY
WY312357OtherBS OF WY