Provider Demographics
NPI:1275049660
Name:DAFRANER ENTERPRISES PLC
Entity Type:Organization
Organization Name:DAFRANER ENTERPRISES PLC
Other - Org Name:DAVID A BECKER SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP
Authorized Official - Phone:616-818-5494
Mailing Address - Street 1:134 PROSPECT AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3321
Mailing Address - Country:US
Mailing Address - Phone:616-818-5494
Mailing Address - Fax:
Practice Address - Street 1:1000 PARCHMENT DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3663
Practice Address - Country:US
Practice Address - Phone:616-957-9112
Practice Address - Fax:616-957-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704269668OtherSTATE NURSE PRACTITIONER LICENSE