MEDICARE: MS. CAROLYN JEAN PAIGE NURSE PRACTITIONER

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	363LA2200X	Adult Health Nurse Practitioner	209002060	IL

General Provider Information

NPI Number	:	1942499983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN JEAN PAIGE NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	641 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2032
Country	:	US
Telephone Number	:	312-747-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2032
Country	:	US
Telephone Number	:	312-747-8900
Fax Number	:

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

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	10/16/2007

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