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General NPI Number Information
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NPI Number | 1417614181
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Entity Type | Individual
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Provider Name | DAVID CARR
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Gender | Male
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 2960 CHARTRES ST
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City | LA SALLE
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State | IL
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Zip | 61301-1031
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Country | US
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Telephone | 815-224-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 3413 BEAVER TRL APT D
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City | AURORA
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State | OH
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Zip | 44202-8523
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2022013042
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | RN.430412
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209027877
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License Number State | IL
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