Provider Demographics
NPI:1235101783
Name:BECK, LORI J (ANP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:BECK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:J
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7229 CLEARVISTA DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1698
Mailing Address - Country:US
Mailing Address - Phone:317-621-4300
Mailing Address - Fax:317-621-4301
Practice Address - Street 1:11645 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3320
Practice Address - Country:US
Practice Address - Phone:317-688-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001752A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000759213OtherANTHEM
IN200290210Medicaid
INP00840402OtherMEDICARE RR
IN7833766OtherAETNA
INQ22164Medicare UPIN
IN000000759213OtherANTHEM
IN200290210Medicaid