Provider Demographics
NPI:1265314579
Name:MISTRO, CARLA C (CNM)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:C
Last Name:MISTRO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 SILVER CROSS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9626
Mailing Address - Country:US
Mailing Address - Phone:815-463-3000
Mailing Address - Fax:815-463-3013
Practice Address - Street 1:1890 SILVER CROSS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9626
Practice Address - Country:US
Practice Address - Phone:815-463-3000
Practice Address - Fax:815-463-3013
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.032768176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty