Provider Demographics
NPI:1811048739
Name:BECKERRN, B J (RN)
Entity type:Individual
Prefix:MS
First Name:B
Middle Name:J
Last Name:BECKERRN
Suffix:
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 1:6283 RIESCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9106
Mailing Address - Country:US
Mailing Address - Phone:262-334-1021
Mailing Address - Fax:262-334-0556
Practice Address - Street 1:6283 RIESCH RD
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9106
Practice Address - Country:US
Practice Address - Phone:262-334-1021
Practice Address - Fax:262-334-0556
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39979100372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3095070OtherPRIOR AUTHROIZATION #