Provider Demographics
NPI:1821654096
Name:BECKETT, ALYSSA MARJORIE (LPN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARJORIE
Last Name:BECKETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 WAYNOKA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WAYNOKA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-9230
Mailing Address - Country:US
Mailing Address - Phone:231-886-0549
Mailing Address - Fax:
Practice Address - Street 1:75 BANTING DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1460
Practice Address - Country:US
Practice Address - Phone:937-378-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.165751.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse