Healthcare Provider Details

I. General information

NPI: 1174522825
Provider Name (Legal Business Name): JASON A CARMAN DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 STATION DR
CRYSTAL LAKE IL
60014
US

IV. Provider business mailing address

360 STATION DR
CRYSTAL LAKE IL
60014-7978
US

V. Phone/Fax

Practice location:
  • Phone: 815-338-6600
  • Fax: 815-455-8044
Mailing address:
  • Phone: 815-338-6600
  • Fax: 815-455-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209000227
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209000227
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: