Provider Demographics
NPI:1609304401
Name:DENMON, BETH ANN (FNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:DENMON
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:6810 STATE ROUTE 162 BOX 215
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-8501
Mailing Address - Country:US
Mailing Address - Phone:618-391-6405
Mailing Address - Fax:618-288-4088
Practice Address - Street 1:6616 CENTER GROVE RD.
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025
Practice Address - Country:US
Practice Address - Phone:618-659-1599
Practice Address - Fax:618-659-1597
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2020-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209015530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
14017183OtherCAQH