Individual
KELLY ANNE BECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
121 BRIDLE RD, BILLERICA, MA 01821-1718
(617) 686-2594
Mailing address
121 BRIDLE RD, BILLERICA, MA 01821-1718
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
263320
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110025292A
—
MA
Enumeration date
10/29/2018
Last updated
10/29/2018
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