Provider Demographics
NPI:1326157595
Name:MATHEWS, BETH (APN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 PATTON DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-8126
Mailing Address - Country:US
Mailing Address - Phone:217-784-2633
Mailing Address - Fax:217-590-0272
Practice Address - Street 1:1504 PATTON DR
Practice Address - Street 2:UNIT 2
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-8126
Practice Address - Country:US
Practice Address - Phone:217-784-2633
Practice Address - Fax:217-590-0272
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000456363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041-177521OtherILL. RN LICENSE#
ILF400299982OtherMEDICARE PTAN
IL209000456OtherILL. APN LICENSE
IL30227022OtherANCC CREDENTIAL #
IL5711821OtherFIRST HEALTH/COVENTRY
ILS67258OtherMEDICARE PIN