MEDICARE: COLEEN ANN CARNEY APN/CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	209007755	IL
2	363LF0000X	Family Nurse Practitioner	209007755	IL

General Provider Information

NPI Number	:	1831422740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLEEN ANN CARNEY APN/CNP

Provider Business Mailing Address
First Line	:	21202 OWENS RD STE 201
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-2038
Country	:	US
Telephone Number	:	779-334-0020
Fax Number	:	779-334-0021

Provider Business Practice Location Address
First Line	:	21202 OWENS RD STE 201
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-2038
Country	:	US
Telephone Number	:	779-334-0020
Fax Number	:	779-334-0021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	05/20/2025

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