Provider Demographics
NPI:1316963317
Name:BECKER, DONNA F (APRN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:F
Last Name:BECKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 HIGHWAY 9
Mailing Address - Street 2:CN2025
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754
Mailing Address - Country:US
Mailing Address - Phone:732-914-3843
Mailing Address - Fax:732-914-3854
Practice Address - Street 1:1691 HIGHWAY 9
Practice Address - Street 2:CN2025
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08754
Practice Address - Country:US
Practice Address - Phone:732-914-3843
Practice Address - Fax:732-914-3854
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC08980400364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB0522741Medicare ID - Type Unspecified