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General NPI Number Information
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NPI Number | 1326157595
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Entity Type | Individual
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Provider Name | BETH MATHEWS APN
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 1504 PATTON DR UNIT 2
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City | MAHOMET
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State | IL
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Zip | 61853-8126
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Country | US
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Telephone | 217-784-2633
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Fax | 217-590-0272
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Provider Business Mailing Address
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Address Line | 1504 PATTON DR UNIT 2
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City | MAHOMET
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State | IL
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Zip | 61853-8126
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Country | US
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Telephone | 217-784-2633
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Fax | 217-590-0272
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209000456
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 209000456
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License Number State | IL
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