MEDICARE: MARY JO BIERMAN APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2090217177	IL
2	363L00000X	Nurse Practitioner	209021717	IL

General Provider Information

NPI Number	:	1588273916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JO BIERMAN APN

Provider Business Mailing Address
First Line	:	PO BOX 372
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-0372
Country	:	US
Telephone Number	:	217-258-2581
Fax Number	:	217-258-2216

Provider Business Practice Location Address
First Line	:	905 N MAPLE ST
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-6401
Country	:	US
Telephone Number	:	217-258-4186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	04/07/2026

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