Provider Demographics
NPI:1073200150
Name:JIMENEZ, CARRIANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIANN
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 MUNICIPAL DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5483
Mailing Address - Country:US
Mailing Address - Phone:815-759-2306
Mailing Address - Fax:815-759-1953
Practice Address - Street 1:3715 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5483
Practice Address - Country:US
Practice Address - Phone:815-759-2306
Practice Address - Fax:815-759-1953
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043101244164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse