Individual
MARIE R CARCELLAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
5101 S WILLOW SPRINGS RD, LA GRANGE, IL 60525-7009
(708) 245-4073
(708) 245-5614
Mailing address
5101 S WILLOW SPRINGS RD, LA GRANGE, IL 60525-7009
(708) 245-4073
(708) 245-5614
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209008874
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208341
GROUP PTAN
—
01
—
208342
MEDICARE GROUP PTAN
—
Enumeration date
10/12/2011
Last updated
02/14/2013
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