Provider Demographics
NPI:1548267909
Name:BECKER, DIANNE L (EMT/DIRECTOR)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:L
Last Name:BECKER
Suffix:
Gender:F
Credentials:EMT/DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67663-3105
Mailing Address - Country:US
Mailing Address - Phone:785-434-2530
Mailing Address - Fax:785-434-2552
Practice Address - Street 1:1111 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:KS
Practice Address - Zip Code:67663-3105
Practice Address - Country:US
Practice Address - Phone:785-434-2530
Practice Address - Fax:785-434-2552
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS007579146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000019099OtherBLUE CROSS BLUE SHIELD
KS019099Medicare PIN