Provider Demographics
NPI:1255545711
Name:REMEN, CAROL (NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:REMEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N LOOMIS ST
Mailing Address - Street 2:STE. 202
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1111
Mailing Address - Country:US
Mailing Address - Phone:773-254-4030
Mailing Address - Fax:773-247-9384
Practice Address - Street 1:321 N LOOMIS ST
Practice Address - Street 2:STE. 202
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1111
Practice Address - Country:US
Practice Address - Phone:773-254-4030
Practice Address - Fax:773-247-9384
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002106363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP17054Medicare UPIN