Healthcare Provider Details

I. General information

NPI: 1437209640
Provider Name (Legal Business Name): JOELLEN CARROLL APRN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

25 N WINFIELD RD
WINFIELD IL
60190-1379
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-6675
  • Fax: 630-933-2614
Mailing address:
  • Phone: 630-933-6675
  • Fax: 630-933-2614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041124584
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209000952
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: