Provider Demographics
NPI:1548621642
Name:BERUMEN, CECILIA (APRN FPA)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:BERUMEN
Suffix:
Gender:F
Credentials:APRN FPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 DUNHAM RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1431
Mailing Address - Country:US
Mailing Address - Phone:630-521-3110
Mailing Address - Fax:630-296-8965
Practice Address - Street 1:451 DUNHAM RD STE 300
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1431
Practice Address - Country:US
Practice Address - Phone:630-521-3110
Practice Address - Fax:630-296-8965
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000059363LF0000X, 363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily