Provider Demographics
NPI:1992956817
Name:BECKER, REBECCA RAE (FNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RAE
Last Name:BECKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781-1048
Mailing Address - Country:US
Mailing Address - Phone:906-643-0407
Mailing Address - Fax:906-643-6188
Practice Address - Street 1:1140 N STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1048
Practice Address - Country:US
Practice Address - Phone:906-643-0407
Practice Address - Fax:906-643-6188
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704222595363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care