Provider Demographics
NPI:1821801994
Name:BLOMQUIST, CARMEN (APRN)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:BLOMQUIST
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:HEBERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 E BIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-1363
Mailing Address - Country:US
Mailing Address - Phone:217-820-0823
Mailing Address - Fax:
Practice Address - Street 1:1836 S MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4000
Practice Address - Country:US
Practice Address - Phone:217-546-0512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily