Healthcare Provider Details

I. General information

NPI: 1992705784
Provider Name (Legal Business Name): CARRIE N NELSON D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 CHASE ST STE 1A
ALGONQUIN IL
60102-9668
US

IV. Provider business mailing address

PO BOX 5670
VILLA PARK IL
60181-5670
US

V. Phone/Fax

Practice location:
  • Phone: 847-705-6765
  • Fax: 630-359-4600
Mailing address:
  • Phone: 847-705-6765
  • Fax: 630-359-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016004921
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016-004921
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: