Provider Demographics
NPI:1093111957
Name:FEID, CARRIE A (APN, CNP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:FEID
Suffix:
Gender:F
Credentials:APN, CNP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:A
Other - Last Name:GALLIMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4405 WEAVER PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3269
Mailing Address - Country:US
Mailing Address - Phone:630-352-5450
Mailing Address - Fax:630-352-5320
Practice Address - Street 1:4405 WEAVER PKWY
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3269
Practice Address - Country:US
Practice Address - Phone:630-352-5450
Practice Address - Fax:630-352-5320
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012059363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
ILF400176921OtherMEDICARE PTAN (INDIVIDUAL)
ILF400176921OtherMEDICARE PTAN (INDIVIDUAL)