Provider Demographics
NPI:1467565317
Name:BECK, KAROLE LYNN (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KAROLE
Middle Name:LYNN
Last Name:BECK
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1360 DUNMARS ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712
Mailing Address - Country:US
Mailing Address - Phone:208-433-9188
Mailing Address - Fax:208-433-9372
Practice Address - Street 1:1617 W JEFFERSON
Practice Address - Street 2:ABUNDANT LIFE HEALTH CARE
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-433-9188
Practice Address - Fax:208-433-9372
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-25885363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP63481Medicare UPIN