Most Relevant Information
Provider Data
| NPI Number: | 1003278581 |
| Provider Name: | BETHANI CHRISTIANSON |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 209014126 |
Most Important Dates
| Enumeration Date: | 03/24/2016 |
| Last Updated: | 02/08/2021 |
Provider Practice Location
2200 FORT JESSE RD STE 110
NORMAL
IL
617616286
Practice Location Phone/Fax
| Phone: | 3096616290 |
| Fax: |
Provider Mailing Location
2200 FORT JESSE RD STE 110
NORMAL
IL
617616286
Provider Mailing Phone/Fax
| Phone: | 3096616290 |
| Fax: |