Provider Demographics
NPI:1407870439
Name:BECKER, SUSAN H (APRN, BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:BECKER
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:H
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN,BC,PC
Mailing Address - Street 1:PO BOX 1782
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02651-1782
Mailing Address - Country:US
Mailing Address - Phone:781-255-0303
Mailing Address - Fax:781-255-0356
Practice Address - Street 1:20 VERNON ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2184
Practice Address - Country:US
Practice Address - Phone:781-255-0303
Practice Address - Fax:781-255-0356
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119469163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS94566Medicare UPIN
MANS0320Medicare ID - Type Unspecified