Provider Demographics
NPI:1396464103
Name:BECKER, JENNA N (NP)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:N
Last Name:BECKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:CRUME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7973 N FRANKFORT RD
Mailing Address - Street 2:
Mailing Address - City:THORNTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46071-9033
Mailing Address - Country:US
Mailing Address - Phone:765-618-3203
Mailing Address - Fax:
Practice Address - Street 1:1 WALTER SCHOLER DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-6303
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28236032A163WE0003X, 363LF0000X
IN71014282A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency