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1407430408

NPI Code Detail

MEDICARE: CARA PARK APN-CNP

MEDICARE: CARA PARK APN-CNP

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	363LN0000X	Neonatal Nurse Practitioner	LM-0010193	DE
2	363L00000X	Nurse Practitioner	209034998	IL
3	163WN0002X	Neonatal Intensive Care Registered Nurse	28230650A	IN
4	363L00000X	Nurse Practitioner	LM-0010193	DE
5	363LN0000X	Neonatal Nurse Practitioner	71011304A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407430408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA PARK APN-CNP

Provider Business Mailing Address
First Line	:	707 CEDAR ST STE 405
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-2059
Country	:	US
Telephone Number	:	574-335-8707
Fax Number	:	574-335-0741

Provider Business Practice Location Address
First Line	:	155 E BRUSH HILL RD
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-5658
Country	:	US
Telephone Number	:	331-221-3007
Fax Number	:

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

Provider Enumeration Date	:	05/06/2021
Last Update Date	:	04/20/2026

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Directions to “ CARA PARK APN-CNP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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