Springfield Elder Care, LLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

209006847 Issued in IL

Legal business name

SPRINGFIELD ELDER CARE, LLC

Practice address

1808 S Bates Ave
Springfield, IL 62704-3354

Phone

(217) 741-4304

NPI assigned

Aug 24, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Elizabeth Dianne Carlson, PH.D, MPH, BSN

Title

Owner

Phone

(217) 741-4304

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282608000000",
    "number": "1386950764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 S BATES AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627043354",
            "telephone_number": "217-741-4304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 S BATES AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627043354",
            "telephone_number": "217-741-4304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGFIELD ELDER CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-24",
        "last_updated": "2010-08-24",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "DIANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-741-4304",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PH.D, MPH, BSN"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209006847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Springfield, IL
• Providers in Springfield, IL by specialty
• Gerontology Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.