Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 209004914 | IL |
NPI | 1013161173 |
---|---|
Provider Name | Nicole W Carlson |
First Address | Chicago, IL 60637-1463 |
Second Address | Chicago, IL 60637-1463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2008 |
Last Update Date | 14/11/2008 |