Provider Demographics
NPI:1538685896
Name:BECKER, JANELL (FNP-C)
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 OWEN DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1633
Mailing Address - Country:US
Mailing Address - Phone:910-223-7246
Mailing Address - Fax:
Practice Address - Street 1:1840 OWEN DR STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3455
Practice Address - Country:US
Practice Address - Phone:910-223-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily