Provider Demographics
NPI:1871331942
Name:CARROLL, MARY KATHERINE (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 W BELMONT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5785
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:312-694-1885
Practice Address - Street 1:1333 W BELMONT AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5785
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:312-694-1885
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030144363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily