Healthcare Provider Details

I. General information

NPI: 1881982866
Provider Name (Legal Business Name): ALLIANCE HEALTHCARE PROVIDERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2189 ASHBY LN
PLAINFIELD IL
60586-5443
US

IV. Provider business mailing address

2189 ASHBY LN
PLAINFIELD IL
60586-5443
US

V. Phone/Fax

Practice location:
  • Phone: 630-508-0891
  • Fax: 630-485-6975
Mailing address:
  • Phone: 630-508-0891
  • Fax: 630-485-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209004954
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1073846440
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerNPPES

VIII. Authorized Official

Name: MRS. JUDY L CARINO
Title or Position: OWNER
Credential: RN, MSN, PCCN,APRN
Phone: 630-508-0891