Healthcare Provider Details

I. General information

NPI: 1689609554
Provider Name (Legal Business Name): CAROL L ALEXANDER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 S STONY ISLAND AVE
CHICAGO IL
60649-3954
US

IV. Provider business mailing address

4988 MEADOW LAKE DR
RICHTON PARK IL
60471-1184
US

V. Phone/Fax

Practice location:
  • Phone: 773-947-7500
  • Fax: 773-947-7792
Mailing address:
  • Phone: 708-747-5948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209005958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: