Provider Demographics
NPI:1316008444
Name:BECKER, ELAINE MARY (CNM, MSN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARY
Last Name:BECKER
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 40TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-5011
Mailing Address - Country:US
Mailing Address - Phone:406-761-4768
Mailing Address - Fax:406-453-2008
Practice Address - Street 1:910 1ST AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2606
Practice Address - Country:US
Practice Address - Phone:406-453-1008
Practice Address - Fax:406-453-2008
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN23136163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTS85147Medicare UPIN