Provider Demographics
NPI:1316671050
Name:BECUKIC, ELVISA
Entity type:Individual
Prefix:
First Name:ELVISA
Middle Name:
Last Name:BECUKIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 30TH AVE S APT 102
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8592
Mailing Address - Country:US
Mailing Address - Phone:701-929-0858
Mailing Address - Fax:
Practice Address - Street 1:5345 30TH AVE S APT 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8592
Practice Address - Country:US
Practice Address - Phone:701-929-0858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant