Provider Demographics
NPI:1356190060
Name:BECKMAN, GENNA ANN (NP)
Entity type:Individual
Prefix:
First Name:GENNA
Middle Name:ANN
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GENNA
Other - Middle Name:ANN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8820 S MERIDIAN ST STE 125
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-6060
Mailing Address - Country:US
Mailing Address - Phone:317-780-4080
Mailing Address - Fax:317-780-4088
Practice Address - Street 1:8820 S MERIDIAN ST STE 125
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-6060
Practice Address - Country:US
Practice Address - Phone:317-780-4080
Practice Address - Fax:317-780-4088
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015130A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300093611Medicaid