Healthcare Provider Details

I. General information

NPI: 1104394493
Provider Name (Legal Business Name): BEATRICE MARIE ANDERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 N VERMILION ST
DANVILLE IL
61832-1100
US

IV. Provider business mailing address

214 EAGLE DR
COVINGTON IN
47932-8504
US

V. Phone/Fax

Practice location:
  • Phone: 217-651-6801
  • Fax:
Mailing address:
  • Phone: 217-260-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209018442
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.018442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: