Provider Demographics
NPI:1205542958
Name:BESWICK, BRADLEY D (FNP)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:D
Last Name:BESWICK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4351
Mailing Address - Country:US
Mailing Address - Phone:217-440-0856
Mailing Address - Fax:
Practice Address - Street 1:102 PRAIRIE MILLS RD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:IL
Practice Address - Zip Code:62339-1055
Practice Address - Country:US
Practice Address - Phone:217-696-4446
Practice Address - Fax:217-696-4452
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily