Provider Demographics
NPI:1073846440
Name:CARINO, JUDY LAU (MSN,ANP,PMHNP,APRN)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LAU
Last Name:CARINO
Suffix:
Gender:F
Credentials:MSN,ANP,PMHNP,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BLACK RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5942
Mailing Address - Country:US
Mailing Address - Phone:815-727-6667
Mailing Address - Fax:
Practice Address - Street 1:800 BLACK RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5942
Practice Address - Country:US
Practice Address - Phone:815-727-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004954363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health