Provider Demographics
NPI:1629327010
Name:BECK, MARY LEE (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LEE
Last Name:BECK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2403 N STOCKTON HILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4188
Mailing Address - Country:US
Mailing Address - Phone:928-255-5050
Mailing Address - Fax:623-227-2000
Practice Address - Street 1:2403 N STOCKTON HILL RD STE 1
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4188
Practice Address - Country:US
Practice Address - Phone:928-255-5050
Practice Address - Fax:623-227-2000
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP5580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily