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General NPI Number Information
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NPI Number | 1326158502
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Entity Type | Individual
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Provider Name | NANCY J. CARLSON MD
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 2400 N ROCKTON AVE
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City | ROCKFORD
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State | IL
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Zip | 61103-3655
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Country | US
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Telephone | 815-971-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 N ROCKTON AVE
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City | ROCKFORD
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State | IL
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Zip | 61103-3655
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Country | US
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Telephone | 815-971-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | MD2016-0001
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | CS00222637
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 336.032045
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 4301076946
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 036-067902
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License Number State | IL
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