Provider Demographics
NPI:1821495268
Name:BECKER, LACEY MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:MARIE
Last Name:BECKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 TIBBALS ST
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1261
Mailing Address - Country:US
Mailing Address - Phone:308-995-2881
Mailing Address - Fax:
Practice Address - Street 1:1215 TIBBALS ST
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1261
Practice Address - Country:US
Practice Address - Phone:308-995-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1127133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered