Provider Demographics
NPI:1700433539
Name:BECK, LORRIE LYNN
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:LYNN
Last Name:BECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 FAWN CT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8360
Mailing Address - Country:US
Mailing Address - Phone:630-280-8700
Mailing Address - Fax:
Practice Address - Street 1:1010 EXECUTIVE DR STE 200
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6184
Practice Address - Country:US
Practice Address - Phone:866-216-5708
Practice Address - Fax:866-216-5707
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019173363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner