Provider Demographics
NPI:1245487727
Name:BECKER, MYRA PEARLINE (LAC)
Entity type:Individual
Prefix:MS
First Name:MYRA
Middle Name:PEARLINE
Last Name:BECKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 128
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2111
Mailing Address - Country:US
Mailing Address - Phone:952-835-6750
Mailing Address - Fax:952-835-4723
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:SUITE 128
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2111
Practice Address - Country:US
Practice Address - Phone:952-835-6750
Practice Address - Fax:952-835-4723
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1427171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist