Provider Demographics
NPI:1508306937
Name:BECKMAN, MICHELLE RENE (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENE
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3070
Mailing Address - Country:US
Mailing Address - Phone:507-340-6805
Mailing Address - Fax:
Practice Address - Street 1:3904 21ST AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3070
Practice Address - Country:US
Practice Address - Phone:507-340-6805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-04
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR211615-4363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1508306937OtherNPI