Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209015570 | IL |
NPI | 1003356874 |
---|---|
Provider Name | Carcena Harvey-Burns |
First Address | Glenview, IL 60025-7635 |
Second Address | Chicago, IL 60661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2017 |
Last Update Date | 11/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14241377 | CAQH (01) | IL |