Provider Demographics
NPI:1770675795
Name:BECKMAN, JONI RAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JONI
Middle Name:RAE
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2451
Mailing Address - Country:US
Mailing Address - Phone:402-484-6677
Mailing Address - Fax:402-484-4476
Practice Address - Street 1:600 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2451
Practice Address - Country:US
Practice Address - Phone:402-489-3802
Practice Address - Fax:402-486-7861
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1324363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083161300Medicaid
NE47078180813Medicaid
NE47083161300Medicaid
NE098991004Medicare PIN