Provider Demographics
NPI:1316786650
Name:BECKUM, DEMETRIA (PHLEBOTOMIST, MA)
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:
Last Name:BECKUM
Suffix:
Gender:F
Credentials:PHLEBOTOMIST, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7159 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1115
Mailing Address - Country:US
Mailing Address - Phone:414-405-2936
Mailing Address - Fax:
Practice Address - Street 1:7159 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1115
Practice Address - Country:US
Practice Address - Phone:414-405-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIT6E3Y5F7246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy