1841277530 NPI number — DIANE S BEECK PA-C

Table of content: DIANE S BEECK PA-C (NPI 1841277530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841277530 NPI number — DIANE S BEECK PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEECK
Provider First Name:
DIANE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841277530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
906 WOODS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTLAND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53029-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-369-8866
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20611 WATERTOWN RD STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53186-1871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-901-4450
Provider Business Practice Location Address Fax Number:
262-395-4256
Provider Enumeration Date:
12/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  735-023 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42950200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000 . This is a "BCBS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com