Organization
OUR MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CECILIA BERUMEN APRN FPA (NURSE PRACTITIONER / PSYCH)
(630) 521-3110
Entity
Organization
Contact information
Practice address
451 DUNHAM RD STE 300, SAINT CHARLES, IL 60174-1431
(630) 521-3110
(630) 296-8965
Mailing address
451 DUNHAM RD STE 300, SAINT CHARLES, IL 60174-1431
(630) 521-3110
(630) 296-8965
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209013778
IL
363LP2300X
Primary Care Nurse Practitioner
209013778
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437547858
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/31/2018
Last updated
07/08/2021
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