Provider Demographics
NPI:1750942421
Name:NURSE, CAROL ANNE
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANNE
Last Name:NURSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 DACY ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3228
Mailing Address - Country:US
Mailing Address - Phone:815-529-0697
Mailing Address - Fax:
Practice Address - Street 1:449 DACY ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3228
Practice Address - Country:US
Practice Address - Phone:815-529-0697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist