Provider Demographics
NPI:1427247915
Name:BECKWITH, SUE ANNE LINDA (LPN)
Entity type:Individual
Prefix:MS
First Name:SUE ANNE
Middle Name:LINDA
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 COUNTY HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13411-3018
Mailing Address - Country:US
Mailing Address - Phone:607-847-8993
Mailing Address - Fax:
Practice Address - Street 1:3370 COUNTY HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13411-3018
Practice Address - Country:US
Practice Address - Phone:607-847-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284083-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse