Healthcare Provider Details

I. General information

NPI: 1518691559
Provider Name (Legal Business Name): CAROLYN KEFFER DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 18-200
CHICAGO IL
60611-5929
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 18-200
CHICAGO IL
60611-5929
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8630
  • Fax: 312-695-2857
Mailing address:
  • Phone: 312-695-8630
  • Fax: 312-695-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.412031
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.024166
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209024166
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: