Provider Demographics
NPI:1124328257
Name:GUTHRIE, BECKY J (FNP)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:J
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23414 80TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PORT BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61275-9633
Mailing Address - Country:US
Mailing Address - Phone:309-337-9187
Mailing Address - Fax:833-907-2398
Practice Address - Street 1:2884 AAA CT
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3406
Practice Address - Country:US
Practice Address - Phone:563-296-3100
Practice Address - Fax:833-907-2398
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008366207V00000X
IAA086738207VG0400X, 363LW0102X
IL209.008366363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology