Healthcare Provider Details

I. General information

NPI: 1164868790
Provider Name (Legal Business Name): EILEEN T CARTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MADISON ST NURSING ADMINISTRATION
JOLIET IL
60435-8200
US

IV. Provider business mailing address

333 MADISON ST NURSING ADMINISTRATION
JOLIET IL
60435-8200
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-7133
  • Fax: 815-773-7892
Mailing address:
  • Phone: 815-725-7133
  • Fax: 815-773-7892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209.007829
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: