Provider Demographics
NPI:1477988087
Name:HONORABLE, CARMEKA D (APRN)
Entity Type:Individual
Prefix:
First Name:CARMEKA
Middle Name:D
Last Name:HONORABLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4965 E LOST BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-5139
Mailing Address - Country:US
Mailing Address - Phone:217-864-5531
Mailing Address - Fax:
Practice Address - Street 1:4965 E LOST BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-5139
Practice Address - Country:US
Practice Address - Phone:217-864-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041382907163W00000X
IL209018332363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse