Provider Demographics
NPI:1922234921
Name:BEARD, NYDIA CARMEL (CNM, WHNP)
Entity Type:Individual
Prefix:MS
First Name:NYDIA
Middle Name:CARMEL
Last Name:BEARD
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436-9700
Mailing Address - Country:US
Mailing Address - Phone:815-741-4396
Mailing Address - Fax:
Practice Address - Street 1:152 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-2619
Practice Address - Country:US
Practice Address - Phone:708-754-9687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007423363LW0102X
IL209.007283367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health