Provider Demographics
NPI:1265533764
Name:BECK, SUSAN ELLEN (CPNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELLEN
Last Name:BECK
Suffix:
Gender:
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-4518
Mailing Address - Country:US
Mailing Address - Phone:517-787-4330
Mailing Address - Fax:517-787-4861
Practice Address - Street 1:2100 4TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-4518
Practice Address - Country:US
Practice Address - Phone:517-787-4330
Practice Address - Fax:517-787-4861
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704219112363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI83 20030OtherPHP