Healthcare Provider Details

I. General information

NPI: 1003356874
Provider Name (Legal Business Name): CARCENA HARVEY-BURNS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 W RANDOLPH ST
CHICAGO IL
60661
US

IV. Provider business mailing address

2050 CLAIRE CT
GLENVIEW IL
60025-7635
US

V. Phone/Fax

Practice location:
  • Phone: 224-770-2424
  • Fax: 847-556-1715
Mailing address:
  • Phone: 224-770-2424
  • Fax: 847-556-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015570
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: