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General NPI Number Information
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NPI Number | 1871982637
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Entity Type | Individual
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Provider Name | BETH ALLAN FPA APRN NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/16/2015
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 701 COLLEGE RD
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City | LEBANON
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State | IL
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Zip | 62254-1291
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Country | US
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Telephone | 618-537-6502
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Fax |
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Provider Business Mailing Address
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Address Line | 9045 E KIRSCH RD
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City | TROY
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State | IL
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Zip | 62294-2527
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Country | US
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Telephone |
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Fax |
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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 | 363LS0200X
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Taxonomy Name | School Nurse Practitioner
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License Number | 277000007
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 277000007
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License Number State | IL
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