Provider Demographics
NPI:1649596982
Name:BERNARD-JUMBO, BEAUTY YIBO (FPA-APRN)
Entity Type:Individual
Prefix:MS
First Name:BEAUTY
Middle Name:YIBO
Last Name:BERNARD-JUMBO
Suffix:
Gender:F
Credentials:FPA-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5811
Mailing Address - Country:US
Mailing Address - Phone:708-933-6556
Mailing Address - Fax:708-933-6556
Practice Address - Street 1:400 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5832
Practice Address - Country:US
Practice Address - Phone:224-545-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 261QU0200X
IL277.002361363L00000X, 363LF0000X
IL209007994363LF0000X
IN71004747A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner