Healthcare Provider Details

I. General information

NPI: 1205542958
Provider Name (Legal Business Name): BRADLEY D BESWICK FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 N 24TH ST
QUINCY IL
62301-3140
US

IV. Provider business mailing address

2308 MAINE ST
QUINCY IL
62301-4351
US

V. Phone/Fax

Practice location:
  • Phone: 217-214-6300
  • Fax: 217-214-6299
Mailing address:
  • Phone: 217-440-0856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209024620
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: