Healthcare Provider Details

I. General information

NPI: 1922234921
Provider Name (Legal Business Name): NYDIA CARMEL BEARD CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 W LINCOLN HWY
CHICAGO HEIGHTS IL
60411-2619
US

IV. Provider business mailing address

3001 BLOOMFIELD DR
JOLIET IL
60436-9700
US

V. Phone/Fax

Practice location:
  • Phone: 708-754-9687
  • Fax:
Mailing address:
  • Phone: 815-741-4396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209.007423
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209.007283
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: