Healthcare Provider Details

I. General information

NPI: 1316337710
Provider Name (Legal Business Name): PATRICIA CARMICHAEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 WILLIAMSBURG DR
NAPERVILLE IL
60540-7122
US

IV. Provider business mailing address

917 WILLIAMSBURG DR
NAPERVILLE IL
60540-7122
US

V. Phone/Fax

Practice location:
  • Phone: 602-796-3097
  • Fax:
Mailing address:
  • Phone: 602-796-3097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.355471
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: