Provider Demographics
NPI:1336144559
Name:BEELAND, MARIJANE RABOIN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARIJANE
Middle Name:RABOIN
Last Name:BEELAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARIJANE
Other - Middle Name:SARAH
Other - Last Name:WOHLLEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4123 DUTCHMANS LN STE 503
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4730
Practice Address - Country:US
Practice Address - Phone:502-409-5600
Practice Address - Fax:502-409-5606
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7100790174400000X
KY3004812363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200489110Medicaid
KYP01300054OtherRR MEDICARE
KYK099480OtherMEDICARE PTAN - WS
IN000000215953OtherBC/BS FACETS
KY7100272410Medicaid
IN500029280OtherMEDICARE RAILROAD
KYP01300054OtherRR MEDICARE