Provider Demographics
NPI:1003823188
Name:BECKMAN, SHONNA COTTON (PA-C)
Entity Type:Individual
Prefix:
First Name:SHONNA
Middle Name:COTTON
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHONNA
Other - Middle Name:MAE
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:455 W COURT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3679
Mailing Address - Country:US
Mailing Address - Phone:815-937-8744
Mailing Address - Fax:815-937-3528
Practice Address - Street 1:455 W COURT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3679
Practice Address - Country:US
Practice Address - Phone:815-937-8744
Practice Address - Fax:815-937-3528
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.002651363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant