Individual
BETH ANN DENMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6616 CENTER GROVE RD., EDWARDSVILLE, IL 62025
(618) 659-1599
(618) 659-1597
Mailing address
6810 STATE ROUTE 162 BOX 215, MARYVILLE, IL 62062-8501
(618) 391-6405
(618) 288-4088
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209015530
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14017183
CAQH
—
Enumeration date
05/24/2017
Last updated
06/23/2020
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