MEDICARE: CAROL REMEN NP

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
1	363LP0200X	Pediatric Nurse Practitioner	209-002106	IL

General Provider Information

NPI Number	:	1255545711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL REMEN NP

Provider Business Mailing Address
First Line	:	321 N LOOMIS ST
Second Line	:	STE. 202
City	:	CHICAGO
State	:	IL
Zip	:	60607-1111
Country	:	US
Telephone Number	:	773-254-4030
Fax Number	:	773-247-9384

Provider Business Practice Location Address
First Line	:	321 N LOOMIS ST
Second Line	:	STE. 202
City	:	CHICAGO
State	:	IL
Zip	:	60607-1111
Country	:	US
Telephone Number	:	773-254-4030
Fax Number	:	773-247-9384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/04/2016

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