Provider Demographics
NPI:1417967589
Name:PAPINEAU, ELAINE MARIE (APN CNS)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:PAPINEAU
Suffix:
Gender:F
Credentials:APN CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N WALL ST STE 206
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2949
Mailing Address - Country:US
Mailing Address - Phone:815-935-7260
Mailing Address - Fax:815-936-7378
Practice Address - Street 1:401 N WALL ST STE 206
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901
Practice Address - Country:US
Practice Address - Phone:815-935-7260
Practice Address - Fax:815-936-7378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002936364S00000X
IL209002936364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP42882Medicare UPIN