Provider Demographics
NPI:1518254077
Name:CAROTHERS, ELZBIETA MARLENA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELZBIETA
Middle Name:MARLENA
Last Name:CAROTHERS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E RANDOLPH ST # CL404
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5014
Mailing Address - Country:US
Mailing Address - Phone:312-653-3300
Mailing Address - Fax:
Practice Address - Street 1:300 E RANDOLPH ST # CL404
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5014
Practice Address - Country:US
Practice Address - Phone:312-653-3300
Practice Address - Fax:312-653-3398
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009561363L00000X
TX719437364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health