Provider Demographics
NPI:1386205672
Name:BECK, HOLLY (IBCLC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 RIO VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1552
Mailing Address - Country:US
Mailing Address - Phone:505-795-6404
Mailing Address - Fax:
Practice Address - Street 1:924 RIO VISTA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1552
Practice Address - Country:US
Practice Address - Phone:505-795-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55895174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM55895OtherLICENSE