Provider Demographics
NPI:1710242797
Name:BECKER, NICOLE ELIZABETH (LVN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:BECKER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:MCVEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15671 LASSELLE ST
Mailing Address - Street 2:UNIT 113
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-4750
Mailing Address - Country:US
Mailing Address - Phone:951-858-5014
Mailing Address - Fax:
Practice Address - Street 1:15671 LASSELLE ST
Practice Address - Street 2:UNIT 113
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-4750
Practice Address - Country:US
Practice Address - Phone:951-858-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN245260164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse