Provider Demographics
NPI:1720112998
Name:BECKER, LORI ANN I (RN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:BECKER
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11034 PFAFF HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-9528
Mailing Address - Country:US
Mailing Address - Phone:585-213-4044
Mailing Address - Fax:
Practice Address - Street 1:201 3RD AVE
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-1232
Practice Address - Country:US
Practice Address - Phone:585-728-5743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY399391-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02071956Medicaid