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NPI Code Detail

MEDICARE: BEAM BEAUTY BAR, PLLC

MEDICARE: BEAM BEAUTY BAR, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner

General Provider Information

NPI Number : 1568171296
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEAM BEAUTY BAR, PLLC
Provider Business Mailing Address
First Line : 7824 MCNAIR RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61102-5622
Country : US
Telephone Number : 815-222-7115
Fax Number :
Provider Business Practice Location Address
First Line : 125 S 4TH ST
Second Line :
City : OREGON
State : IL
Zip : 61061-1609
Country : US
Telephone Number : 815-222-7115
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JUSTINE LYN BEAMAN
Credential : NP
Telephone Number : 815-222-7115
Provider Enumeration Date : 11/21/2022
Last Update Date : 03/13/2026

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