Provider Demographics
NPI:1932267838
Name:BECKER, REGINA M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:M
Last Name:BECKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 MOLECULAR DR
Mailing Address - Street 2:STE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7542
Mailing Address - Country:US
Mailing Address - Phone:301-610-4000
Mailing Address - Fax:
Practice Address - Street 1:10110 MOLECULAR DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7542
Practice Address - Country:US
Practice Address - Phone:301-610-0000
Practice Address - Fax:301-610-4007
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR056696363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P31460Medicare UPIN
007275M92Medicare ID - Type Unspecified