Healthcare Provider Details

I. General information

NPI: 1477035855
Provider Name (Legal Business Name): CARLINE CASSANDRA GUERRIER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2018
Last Update Date: 09/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 RIDGE AVE
EVANSTON IL
60202-3328
US

IV. Provider business mailing address

1356 S WILD MEADOW RD
ROUND LAKE IL
60073-4275
US

V. Phone/Fax

Practice location:
  • Phone: 847-316-4000
  • Fax: 847-316-4107
Mailing address:
  • Phone: 847-414-1085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209016057
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209016057
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209016057
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041328923
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: