Provider Demographics
NPI:1104229590
Name:BEAVERS, ERIN N (APN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:N
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:APN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 READ ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3265
Mailing Address - Country:US
Mailing Address - Phone:630-226-5300
Mailing Address - Fax:
Practice Address - Street 1:300 READ ST
Practice Address - Street 2:SUITE D
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3265
Practice Address - Country:US
Practice Address - Phone:630-226-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041353464163W00000X
IL209011956363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse