Individual
MRS. BETH N DIVIACCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3333 CENTRAL ST, EVANSTON, IL 60201-1150
(866) 389-2727
Mailing address
3333 CENTRAL ST, EVANSTON, IL 60201-1150
(866) 389-2727
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041330785
IL
363LF0000X
Family Nurse Practitioner
209.336026
IL
363LF0000X
Family Nurse Practitioner
Primary
209006326
IL
Other
Enumeration date
06/19/2009
Last updated
01/08/2025
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