Healthcare Provider Details

I. General information

NPI: 1972792497
Provider Name (Legal Business Name): PATRICIA L CARR C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2007
Last Update Date: 10/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EASTLAND DR STE. 250
BLOOMINGTON IL
61701-3534
US

IV. Provider business mailing address

1505 EASTLAND DR STE. 250
BLOOMINGTON IL
61701-3534
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-6338
  • Fax:
Mailing address:
  • Phone: 309-663-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: