Provider Demographics
NPI:1619279874
Name:BECKER, KRISTEN ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WI
Mailing Address - Zip Code:54479-9357
Mailing Address - Country:US
Mailing Address - Phone:715-207-5533
Mailing Address - Fax:
Practice Address - Street 1:1108 ASPEN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WI
Practice Address - Zip Code:54479-9357
Practice Address - Country:US
Practice Address - Phone:715-207-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-21
Last Update Date:2010-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI159784163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse