Healthcare Provider Details

I. General information

NPI: 1659159374
Provider Name (Legal Business Name): MICHELLE LYNN BEESLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 3RD AVE
ROCK ISLAND IL
61201-8840
US

IV. Provider business mailing address

2751 BROOKVIEW RD
MUSCATINE IA
52761-9784
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-2094
  • Fax:
Mailing address:
  • Phone: 319-541-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: