Provider Demographics
NPI:1689726945
Name:BECKER, SCOTT ALFRED (RN)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALFRED
Last Name:BECKER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:127 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3315
Mailing Address - Country:US
Mailing Address - Phone:414-258-2588
Mailing Address - Fax:414-535-5957
Practice Address - Street 1:4828 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3440
Practice Address - Country:US
Practice Address - Phone:414-535-5826
Practice Address - Fax:414-535-5957
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI110464163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine