Provider Demographics
NPI:1962671206
Name:DEMARS, BECKY C (NP)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:C
Last Name:DEMARS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:C
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9202 SPRATT LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6905
Mailing Address - Country:US
Mailing Address - Phone:704-384-9679
Mailing Address - Fax:704-316-0508
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-384-5416
Practice Address - Fax:704-384-5992
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC930062363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal