Provider Demographics
NPI:1255925236
Name:BEARNOD, AIDA RUTH GABO (NP)
Entity type:Individual
Prefix:
First Name:AIDA RUTH
Middle Name:GABO
Last Name:BEARNOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:AIDA
Other - Middle Name:GABO
Other - Last Name:BEARNOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:33831 N SUMMERFIELDS DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4273
Mailing Address - Country:US
Mailing Address - Phone:847-337-5323
Mailing Address - Fax:847-604-6708
Practice Address - Street 1:33831 N SUMMERFIELDS DR
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4273
Practice Address - Country:US
Practice Address - Phone:847-337-5323
Practice Address - Fax:847-604-6708
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024085363LF0000X
IL041.287233163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice