Individual
NINA R BECKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
321 W MAIN ST, GRANGEVILLE, ID 83530-1917
(630) 605-9616
Mailing address
1432 HIGHWAY 13, GRANGEVILLE, ID 83530-5006
(630) 605-9616
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
MASH-2190
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
UNKNOWN
—
Enumeration date
07/25/2017
Last updated
07/25/2017
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