Individual
MS. LAURIE JEAN BEAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FAMILY NURSE PRACTIT
Contact information
Practice address
8590 SAINT LUKES DR, BEARDSTOWN, IL 62618-8398
(217) 323-2242
(217) 452-7245
Mailing address
RR 1 BOX 130, GREENFIELD, IL 62044
(217) 368-3001
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209 000817
IL
363LP0200X
Pediatric Nurse Practitioner
209 000817
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370661499007
—
IL
Enumeration date
09/06/2006
Last updated
09/21/2010
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