Provider Demographics
NPI:1265906291
Name:BECKER, DANI SUE (FNP)
Entity type:Individual
Prefix:
First Name:DANI
Middle Name:SUE
Last Name:BECKER
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 1:3515 AUTUMN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3559
Mailing Address - Country:US
Mailing Address - Phone:765-561-1110
Mailing Address - Fax:
Practice Address - Street 1:1655 N GLADSTONE AVE STE E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5380
Practice Address - Country:US
Practice Address - Phone:812-376-3071
Practice Address - Fax:812-375-2903
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008861A363L00000X
IN28132755A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner