Provider Demographics
NPI:1770683278
Name:BECK, CHARLENE G (CNP)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:G
Last Name:BECK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:G
Other - Last Name:GEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-0299
Mailing Address - Country:US
Mailing Address - Phone:575-356-6652
Mailing Address - Fax:575-359-6827
Practice Address - Street 1:42121 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130
Practice Address - Country:US
Practice Address - Phone:575-356-6652
Practice Address - Fax:575-359-6827
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01841363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health