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General NPI Number Information
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NPI Number | 1316439722
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Entity Type | Organization
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Legal Business Name | OUR MEDICAL CENTER LLC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 451 DUNHAM RD STE 300
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City | SAINT CHARLES
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State | IL
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Zip | 60174-1431
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Country | US
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Telephone | 630-521-3110
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Fax | 630-296-8965
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Provider Business Mailing Address
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Address Line | 451 DUNHAM RD STE 300
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City | SAINT CHARLES
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State | IL
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Zip | 60174-1431
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Country | US
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Telephone | 630-521-3110
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Fax | 630-296-8965
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Authorized Official
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Title or Position | NURSE PRACTITIONER / PSYCH
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Name | CECILIA BERUMEN
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Credential | APRN FPA
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Telephone | 630-521-3110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 209013778
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209013778
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License Number State | IL
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