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NPI Code Detail

MEDICARE: MRS. CAROL PALMER WARDLAW RN,APN

MEDICARE: MRS. CAROL PALMER WARDLAW RN,APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP2201XAmbulatory Care Registered Nurse209002606IL

General Provider Information

NPI Number : 1194942029
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROL PALMER WARDLAW RN,APN
Provider Business Mailing Address
First Line : 13000 MAPLE AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-2318
Country : US
Telephone Number : 708-385-6100
Fax Number : 708-385-2051
Provider Business Practice Location Address
First Line : 13000 MAPLE AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-2318
Country : US
Telephone Number : 708-385-6100
Fax Number : 708-385-2051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2007
Last Update Date : 06/07/2012

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