Provider Demographics
NPI:1174724777
Name:BECKER, PAULETTE L (NP-C)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:L
Last Name:BECKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-0339
Mailing Address - Country:US
Mailing Address - Phone:937-864-7363
Mailing Address - Fax:937-864-5895
Practice Address - Street 1:7790 DAYTON SPRINGFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-1957
Practice Address - Country:US
Practice Address - Phone:937-864-7363
Practice Address - Fax:937-864-5895
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP0871055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP75675Medicare UPIN