Provider Demographics
NPI:1194887331
Name:DUNIVAN, CAROLEE JAYNE (CNM)
Entity type:Individual
Prefix:MS
First Name:CAROLEE
Middle Name:JAYNE
Last Name:DUNIVAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:CAROLEE
Other - Middle Name:JAYNE
Other - Last Name:ZUPSICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1532 OSTRANDER AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1354
Mailing Address - Country:US
Mailing Address - Phone:708-482-0098
Mailing Address - Fax:
Practice Address - Street 1:4769 W CERMAK RD
Practice Address - Street 2:MILE SQUARE HEALTH CENTER AT CICERO
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2508
Practice Address - Country:US
Practice Address - Phone:312-413-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585551163W00000X
CANMW 1535367A00000X
IL041-221584163W00000X
IL209-001585367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse