Basic Information
| Provider Information | |||||||||
| NPI: | 1003356874 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARVEY-BURNS | ||||||||
| FirstName: | CARCENA | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 CLAIRE CT | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600257635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2247702424 | ||||||||
| FaxNumber: | 8475561715 | ||||||||
| Practice Location | |||||||||
| Address1: | 549 W RANDOLPH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2247702424 | ||||||||
| FaxNumber: | 8475561715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2017 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209015570 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 14241377 | 01 | IL | CAQH | OTHER |