Provider Demographics
NPI:1316997208
Name:PIERARD, CAROLLYN (APRN)
Entity type:Individual
Prefix:MRS
First Name:CAROLLYN
Middle Name:
Last Name:PIERARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:CARI
Other - Middle Name:
Other - Last Name:PIERARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:159-418-9124
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:1300 DRESDEN DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-2476
Practice Address - Country:US
Practice Address - Phone:815-942-5200
Practice Address - Fax:815-942-5330
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005560363LA2200X
IL277.000949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL277.000949OtherLICENSE
ILK19426Medicare PIN
ILK19427Medicare PIN