Provider Demographics
NPI:1184988388
Name:HELLE, CARRIE LYNNE (APN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNNE
Last Name:HELLE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 ROWE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-2133
Mailing Address - Country:US
Mailing Address - Phone:309-338-6240
Mailing Address - Fax:854-333-4482
Practice Address - Street 1:304 ROWE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-2133
Practice Address - Country:US
Practice Address - Phone:309-338-6240
Practice Address - Fax:854-333-4482
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277002310363LP0808X
IL041298311163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL193200000XMedicaid