Roth, Carolyn

Roth, Carolyn is an individual health care provider with primary practice located at 1701 E College Ave , Bloomington IL 61704-2101. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Roth, Carolyn can be contacted via phone (309) 664-3038.

Contact Information

Primary practice address
1701 E College Ave Bloomington IL 61704-2101
Phone: (309) 664-3038
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209000155 Illinois

Profile Details

NPI number 1679609630
LBN Legal business name Roth, Carolyn
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 26th, 2007
Last updated Nov 20th, 2009 - about 15 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 1679609630 NPPES
Illinois Other IL2613 MEDICARE GROUP PTAN

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