Healthcare Provider Details

I. General information

NPI: 1154905503
Provider Name (Legal Business Name): LENORA BEETS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16116 INVERRARY LN
BLOOMINGTON IL
61705-5580
US

IV. Provider business mailing address

1724 MORRIS AVE NW
CEDAR RAPIDS IA
52405-5247
US

V. Phone/Fax

Practice location:
  • Phone: 309-830-3968
  • Fax:
Mailing address:
  • Phone: 319-431-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: