Provider Demographics
NPI:1497763882
Name:CARLSON, RACHEL J (APN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:J
Other - Last Name:TRUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:726 S WEBER RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-5451
Mailing Address - Country:US
Mailing Address - Phone:630-378-9785
Mailing Address - Fax:630-378-9836
Practice Address - Street 1:1280 WINDHAM PKWY # 104
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1673
Practice Address - Country:US
Practice Address - Phone:630-378-9785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006040363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner