Provider Demographics
NPI:1669845434
Name:NTUM, GERALDINE BEMABOU (NP)
Entity Type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:BEMABOU
Last Name:NTUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 TRAILS END LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-3291
Mailing Address - Country:US
Mailing Address - Phone:630-544-4782
Mailing Address - Fax:
Practice Address - Street 1:1617 TRAILS END LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-3291
Practice Address - Country:US
Practice Address - Phone:630-544-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily