Provider Demographics
NPI:1104394493
Name:ANDERSON, BEATRICE MARIE (APRN)
Entity type:Individual
Prefix:
First Name:BEATRICE
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47932-8504
Mailing Address - Country:US
Mailing Address - Phone:217-260-1433
Mailing Address - Fax:
Practice Address - Street 1:3545 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1100
Practice Address - Country:US
Practice Address - Phone:217-651-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018442363LA2200X
IL209.018442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner