Provider Demographics
NPI:1215936422
Name:BECK, NELDA (CRNA)
Entity type:Individual
Prefix:MISS
First Name:NELDA
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6467
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-6467
Mailing Address - Country:US
Mailing Address - Phone:843-679-3251
Mailing Address - Fax:843-679-3251
Practice Address - Street 1:700 S PARKER DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6059
Practice Address - Country:US
Practice Address - Phone:843-679-3251
Practice Address - Fax:843-679-3251
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC199996367500000X
SCAPN2884367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052191Medicaid
SCAN1475Medicaid
SCAN1475Medicaid
NC8052191Medicaid