Provider Demographics
NPI:1306089289
Name:BECK, MELISSA RENEE (CRNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:BECK
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 1:7109 POOLE JONES RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2451
Mailing Address - Country:US
Mailing Address - Phone:252-258-0578
Mailing Address - Fax:
Practice Address - Street 1:400 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4506
Practice Address - Country:US
Practice Address - Phone:240-566-3447
Practice Address - Fax:240-566-3061
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC104343077363LN0000X
MDR206033363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal