Individual
BETH MATHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1504 PATTON DR, UNIT 2, MAHOMET, IL 61853-8126
(217) 784-2633
(217) 590-0272
Mailing address
1504 PATTON DR, UNIT 2, MAHOMET, IL 61853-8126
(217) 784-2633
(217) 590-0272
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209000456
IL
363LP2300X
Primary Care Nurse Practitioner
Primary
209000456
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041-177521
ILL. RN LICENSE#
IL
01
—
209000456
ILL. APN LICENSE
IL
01
—
30227022
ANCC CREDENTIAL #
IL
01
—
5711821
FIRST HEALTH/COVENTRY
IL
01
—
F400299982
MEDICARE PTAN
IL
01
—
S67258
MEDICARE PIN
IL
Enumeration date
08/30/2006
Last updated
03/12/2018
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