Provider Demographics
NPI:1528549474
Name:DUBORD, CAROLINE HAUGHEY (APRN)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:HAUGHEY
Last Name:DUBORD
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 1:675 N SAINT CLAIR ST STE 19-250
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5964
Mailing Address - Country:US
Mailing Address - Phone:312-695-6022
Mailing Address - Fax:312-695-5672
Practice Address - Street 1:675 N SAINT CLAIR ST STE 19-250
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5964
Practice Address - Country:US
Practice Address - Phone:312-695-6022
Practice Address - Fax:312-695-5672
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041429204163W00000X, 163WS0121X
IL209.018088363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health