Provider Demographics
NPI:1417660762
Name:WILLY, CARLA LOUISE (RN, BSN, CCM)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:LOUISE
Last Name:WILLY
Suffix:
Gender:F
Credentials:RN, BSN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30W346 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1954
Mailing Address - Country:US
Mailing Address - Phone:630-983-0706
Mailing Address - Fax:630-983-9318
Practice Address - Street 1:30W346 BRIAR LN
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1954
Practice Address - Country:US
Practice Address - Phone:312-806-8323
Practice Address - Fax:630-983-9318
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041218397163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041218397OtherIDPR