Healthcare Provider Details

I. General information

NPI: 1437434982
Provider Name (Legal Business Name): ABBI CARR N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E COLLEGE AVE
BLOOMINGTON IL
61704-2101
US

IV. Provider business mailing address

1701 E COLLEGE AVE
BLOOMINGTON IL
61704-2101
US

V. Phone/Fax

Practice location:
  • Phone: 309-664-3120
  • Fax: 309-663-5742
Mailing address:
  • Phone: 309-664-3120
  • Fax: 309-663-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009142
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: