Provider Demographics
NPI:1417403494
Name:BECKER, LAURA H (CRNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:BECKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:H
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1220B E JOPPA RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5813
Mailing Address - Country:US
Mailing Address - Phone:410-494-1888
Mailing Address - Fax:
Practice Address - Street 1:1220B E JOPPA RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-5813
Practice Address - Country:US
Practice Address - Phone:410-494-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR214479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily