Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209014126 | IL |
NPI | 1003278581 |
---|---|
Provider Name | Bethani Christianson |
First Address | Normal, IL 61761-6286 |
Second Address | Normal, IL 61761-6286 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2016 |
Last Update Date | 08/02/2021 |