Provider Demographics
NPI:1952682320
Name:BECKNER, DENA (PA)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:BECKNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21550-3527
Mailing Address - Country:US
Mailing Address - Phone:540-810-5401
Mailing Address - Fax:
Practice Address - Street 1:311 N 4TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1371
Practice Address - Country:US
Practice Address - Phone:301-334-7855
Practice Address - Fax:301-334-7828
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005723363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant