Healthcare Provider Details

I. General information

NPI: 1326157595
Provider Name (Legal Business Name): BETH MATHEWS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 PATTON DR UNIT 2
MAHOMET IL
61853-8126
US

IV. Provider business mailing address

1504 PATTON DR UNIT 2
MAHOMET IL
61853-8126
US

V. Phone/Fax

Practice location:
  • Phone: 217-784-2633
  • Fax: 217-590-0272
Mailing address:
  • Phone: 217-784-2633
  • Fax: 217-590-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209000456
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209000456
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: