Healthcare Provider Details

I. General information

NPI: 1972012060
Provider Name (Legal Business Name): JESSICA CROWELL BUMPUS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W GALENA BLVD
AURORA IL
60506-4305
US

IV. Provider business mailing address

1901 W GALENA BLVD
AURORA IL
60506-4305
US

V. Phone/Fax

Practice location:
  • Phone: 630-692-5960
  • Fax: 630-692-5961
Mailing address:
  • Phone: 630-592-5960
  • Fax: 630-692-5961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277002020
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: