Provider Demographics
NPI:1811469497
Name:KORANDA, CARLY L (DNP, APN, PNP-PC,)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:L
Last Name:KORANDA
Suffix:
Gender:F
Credentials:DNP, APN, PNP-PC,
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:L
Other - Last Name:ROSCOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1121 N LEAVITT ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 ENTERPRISE DR STE 220
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4202
Practice Address - Country:US
Practice Address - Phone:844-632-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2090188342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry