Provider Demographics
NPI:1356908073
Name:ILLG, CARRIE (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ILLG
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DOW JONES AVE
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3089
Mailing Address - Country:US
Mailing Address - Phone:603-889-3667
Mailing Address - Fax:603-886-1805
Practice Address - Street 1:5 DOW JONES AVE
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3089
Practice Address - Country:US
Practice Address - Phone:603-889-3667
Practice Address - Fax:603-886-1805
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH053389-23363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily