Healthcare Provider Details

I. General information

NPI: 1366453698
Provider Name (Legal Business Name): CAROL MAIN-BENNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 NORTHWEST HWY SUITE 7- ATTN RAYLENE BOYD
FOX RIVER GROVE IL
60021-1925
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-829-1600
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209-003422
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: