Provider Demographics
NPI:1366411068
Name:BECKER, BETSY MARIE (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:MARIE
Last Name:BECKER
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:BETSY
Other - Middle Name:MARIE
Other - Last Name:BERNADT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:99 EAST STATE STREET
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-0010
Mailing Address - Country:US
Mailing Address - Phone:518-775-4205
Mailing Address - Fax:518-775-4225
Practice Address - Street 1:99 E STATE ST
Practice Address - Street 2:NATHAN LITTAUER HOSPITAL & NURSING HOME
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1203
Practice Address - Country:US
Practice Address - Phone:518-775-4205
Practice Address - Fax:518-775-4225
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1366411068OtherMVP HEALTHPLAN
NY000418968001OtherBSH NE NY
J400001519Medicare PIN