Provider Demographics
NPI:1306494877
Name:BECK, GERALD (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:BECK
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:MR
Other - First Name:JERRY
Other - Middle Name:M
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3110 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436-9705
Mailing Address - Country:US
Mailing Address - Phone:815-351-4573
Mailing Address - Fax:
Practice Address - Street 1:8135 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1701
Practice Address - Country:US
Practice Address - Phone:219-513-2000
Practice Address - Fax:219-513-2001
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily