Provider Demographics
NPI:1871255315
Name:BECK, CHARLEY CHIPS (FNP)
Entity Type:Individual
Prefix:
First Name:CHARLEY
Middle Name:CHIPS
Last Name:BECK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2953 SALONIE LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7968
Mailing Address - Country:US
Mailing Address - Phone:209-289-3808
Mailing Address - Fax:
Practice Address - Street 1:400 E ORANGEBURG AVE STE 3
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5365
Practice Address - Country:US
Practice Address - Phone:209-578-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily