Fortman, Carrie S

Fortman, Carrie S is an individual health care provider with primary practice located at 1600 N Randall Rd , Elgin IL 60123. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Fortman, Carrie S can be contacted via phone (847) 214-5100.

Contact Information

Primary practice address
1600 N Randall Rd Elgin IL 60123
Phone: (847) 214-5100
Fax: (847) 289-5579
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085001080 Illinois

Profile Details

NPI number 1336211549
LBN Legal business name Fortman, Carrie S
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 14th, 2006
Last updated Mar 11th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336211549 NPPES
Illinois Other 206147 MEDICARE GROUP PTAN
Illinois Other F400138108 MEDICARE GROUP PTAN

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