Provider Demographics
NPI:1003356874
Name:HARVEY-BURNS, CARCENA (APN)
Entity Type:Individual
Prefix:
First Name:CARCENA
Middle Name:
Last Name:HARVEY-BURNS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 CLAIRE CT
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7635
Mailing Address - Country:US
Mailing Address - Phone:224-770-2424
Mailing Address - Fax:847-556-1715
Practice Address - Street 1:549 W RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661
Practice Address - Country:US
Practice Address - Phone:224-770-2424
Practice Address - Fax:847-556-1715
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14241377OtherCAQH