Provider Demographics
NPI:1831536416
Name:BECKFORD, ABBI LAKE (RN)
Entity type:Individual
Prefix:MRS
First Name:ABBI
Middle Name:LAKE
Last Name:BECKFORD
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 1:2151 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8870
Mailing Address - Country:US
Mailing Address - Phone:843-559-4361
Mailing Address - Fax:
Practice Address - Street 1:3464 RIVER RD
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-8820
Practice Address - Country:US
Practice Address - Phone:843-557-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR63748163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool