Provider Demographics
NPI:1518460344
Name:BEICKE, COURTNEY P (LPN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:P
Last Name:BEICKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 ALBERTA DR APT 1
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1302
Mailing Address - Country:US
Mailing Address - Phone:716-370-9726
Mailing Address - Fax:
Practice Address - Street 1:455 ALBERTA DR APT 1
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1302
Practice Address - Country:US
Practice Address - Phone:716-370-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329782-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid