Provider Demographics
NPI:1497884134
Name:BEVERLIN, STEFANI JANE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:STEFANI
Middle Name:JANE
Last Name:BEVERLIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:STEFANI
Other - Middle Name:JANE
Other - Last Name:VOUDRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-0784
Mailing Address - Country:US
Mailing Address - Phone:217-342-3337
Mailing Address - Fax:217-347-3328
Practice Address - Street 1:912 N HENRIETTA ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1788
Practice Address - Country:US
Practice Address - Phone:217-342-3337
Practice Address - Fax:217-347-3328
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0023192255A2300X
IL085005584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer