Provider Demographics
NPI:1144635335
Name:BECKER, ALLISON MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:BECKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:MOGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 86430
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6430
Mailing Address - Country:US
Mailing Address - Phone:605-782-8305
Mailing Address - Fax:605-336-1677
Practice Address - Street 1:1035 S HIGHLINE PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-1000
Practice Address - Country:US
Practice Address - Phone:605-322-2945
Practice Address - Fax:605-322-2926
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant