Individual
BETH ANN DEKONINCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
207 E MEADOW RD STE 6, EDEN, NC 27288-3469
(219) 204-1854
Mailing address
207 E MEADOW RD STE 6, EDEN, NC 27288-3469
(219) 204-1854
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
71000315A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000372024
ANTHEM PROVIDER NUMBER
IN
05
—
200169950
—
IN
01
—
9397614
PHCS PID NUMBER
IN
Enumeration date
03/21/2006
Last updated
11/26/2019
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