Healthcare Provider Details

I. General information

NPI: 1831422740
Provider Name (Legal Business Name): COLEEN ANN CARNEY APN/CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21202 OWENS RD STE 201
MOKENA IL
60448-2038
US

IV. Provider business mailing address

21202 OWENS RD STE 201
MOKENA IL
60448-2038
US

V. Phone/Fax

Practice location:
  • Phone: 779-334-0020
  • Fax: 779-334-0021
Mailing address:
  • Phone: 779-334-0020
  • Fax: 779-334-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209007755
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209007755
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: