Provider Demographics
NPI:1841277530
Name:BEECK, DIANE S (PA-C)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:S
Last Name:BEECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 WOODS DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2900
Mailing Address - Country:US
Mailing Address - Phone:262-369-8866
Mailing Address - Fax:
Practice Address - Street 1:20611 WATERTOWN RD STE E
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1871
Practice Address - Country:US
Practice Address - Phone:262-901-4450
Practice Address - Fax:262-395-4256
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI735-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42950200Medicaid
WI000OtherBCBS
WIP79182Medicare UPIN
WI020201940Medicare PIN
WI000OtherBCBS
970030814Medicare PIN