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General NPI Number Information
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NPI Number | 1255925236
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Entity Type | Individual
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Provider Name | AIDA RUTH GABO BEARNOD NP
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Gender | Female
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Dates
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Enumeration Date | 02/21/2021
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 33831 N SUMMERFIELDS DR
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City | GURNEE
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State | IL
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Zip | 60031-4273
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Country | US
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Telephone | 847-337-5323
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Fax | 847-604-6708
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Provider Business Mailing Address
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Address Line | 33831 N SUMMERFIELDS DR
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City | GURNEE
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State | IL
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Zip | 60031-4273
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Country | US
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Telephone | 847-337-5323
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Fax | 847-604-6708
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.024085
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 041.287233
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License Number State | IL
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