Provider Demographics
NPI:1811326317
Name:CALHOUN, CAROLYN ANN (APN, CNM)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ANN
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:APN, CNM
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:STROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, CNM
Mailing Address - Street 1:2214 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-3221
Mailing Address - Country:US
Mailing Address - Phone:309-680-7600
Mailing Address - Fax:309-681-8443
Practice Address - Street 1:2321 N WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-5613
Practice Address - Country:US
Practice Address - Phone:309-680-7600
Practice Address - Fax:309-681-8443
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010720367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5433001Medicaid