Provider Demographics
NPI:1760575682
Name:BECK, LISA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10978 DONNER PASS RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0433
Mailing Address - Country:US
Mailing Address - Phone:530-582-1212
Mailing Address - Fax:530-587-4278
Practice Address - Street 1:10978 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0433
Practice Address - Country:US
Practice Address - Phone:530-582-1212
Practice Address - Fax:530-587-4278
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA798363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP57450Medicare UPIN