Provider Demographics
NPI:1295067411
Name:MARY BECKER, LLC
Entity type:Organization
Organization Name:MARY BECKER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMSER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:502-896-8660
Mailing Address - Street 1:4121 DUTCHMANS LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4707
Mailing Address - Country:US
Mailing Address - Phone:502-896-8660
Mailing Address - Fax:502-896-5863
Practice Address - Street 1:4121 DUTCHMANS LN
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-896-8660
Practice Address - Fax:502-896-5863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-13
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2137P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1952305807OtherINDIVIDUAL NPI