MEDICARE: CAROL ANN NUFER

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	247ZC0005X	Clinical Laboratory Director (Non-physician)	MT-170462	IL

General Provider Information

NPI Number	:	1912193079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL ANN NUFER

Provider Business Mailing Address
First Line	:	7211 JACKSON BLVD
Second Line	:	#2
City	:	FOREST PARK
State	:	IL
Zip	:	60130-3247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7211 JACKSON BLVD
Second Line	:	#2
City	:	FOREST PARK
State	:	IL
Zip	:	60130-3247
Country	:	US
Telephone Number	:	708-488-1453
Fax Number	:

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

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	09/21/2007

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