Healthcare Provider Details

I. General information

NPI: 1821801994
Provider Name (Legal Business Name): CARMEN BLOMQUIST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARMEN HEBERLING

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 S MACARTHUR BLVD
SPRINGFIELD IL
62704-4000
US

IV. Provider business mailing address

305 E BIDWELL ST
TAYLORVILLE IL
62568-1363
US

V. Phone/Fax

Practice location:
  • Phone: 217-546-0512
  • Fax:
Mailing address:
  • Phone: 217-820-0823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209023659
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: