Provider Demographics
NPI:1568846343
Name:CARLSON, STEVEN M (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:CARLSON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 FLETCHER DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4747
Mailing Address - Country:US
Mailing Address - Phone:847-741-0398
Mailing Address - Fax:847-741-0549
Practice Address - Street 1:745 FLETCHER DR
Practice Address - Street 2:SUITE 301
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4747
Practice Address - Country:US
Practice Address - Phone:847-741-0398
Practice Address - Fax:847-741-0549
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7944363LF0000X
IL209.013669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400305074Medicare PIN