MEDICARE: MRS. NIKKI CARLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	020.007412	IL

General Provider Information

NPI Number	:	1235904350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NIKKI CARLS

Provider Business Mailing Address
First Line	:	24 SENECA TRL
Second Line	:
City	:	PANA
State	:	IL
Zip	:	62557-9719
Country	:	US
Telephone Number	:	217-820-3434
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 SENECA TRL
Second Line	:
City	:	PANA
State	:	IL
Zip	:	62557-9719
Country	:	US
Telephone Number	:	217-820-3434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	11/20/2023

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Directions to “ MRS. NIKKI CARLS ” Practice Location

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