Provider Demographics
NPI:1730427501
Name:BECKEMEYER, PATRICIA MARY (RD)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARY
Last Name:BECKEMEYER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 BIENTERRA TRL
Mailing Address - Street 2:APT 8
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5870
Mailing Address - Country:US
Mailing Address - Phone:815-262-4518
Mailing Address - Fax:
Practice Address - Street 1:251 BIENTERRA TRL
Practice Address - Street 2:APT 8
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5870
Practice Address - Country:US
Practice Address - Phone:815-262-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004587133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered