Active NPI
Carrie Louise Tillman, REGISTERED NURSE
- Registered Nurse
- Harvey, IL
National Provider Identifier
1700385242
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 041356509
- Practice address
- 16215 Woodbridge Ave
Harvey, IL 60426-5946 - Phone
- (708) 203-1755
- NPI assigned
- Feb 11, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 041356509 | IL | Primary |
Addresses
Primary practice location
16215 Woodbridge Ave
Harvey, IL 60426-5946
Mailing address
16215 Woodbridge Ave
Harvey, IL 60426-5946
Phone (708) 203-1755
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 163W0000X | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041356509 | IL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518307200000",
"number": "1700385242",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16215 WOODBRIDGE AVE",
"city": "HARVEY",
"state": "IL",
"postal_code": "604265946",
"telephone_number": "708-203-1755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16215 WOODBRIDGE AVE",
"city": "HARVEY",
"state": "IL",
"postal_code": "604265946",
"telephone_number": "708-203-1755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLMAN",
"first_name": "CARRIE",
"middle_name": "LOUISE",
"credential": "REGISTERED NURSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-11",
"last_updated": "2018-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IL",
"license": "041356509",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "163W0000X",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harvey, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.