Provider Demographics
NPI:1548833205
Name:FLOCK, CARRIE ELAINE (RN, MSN)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ELAINE
Last Name:FLOCK
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 N ROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1593
Mailing Address - Country:US
Mailing Address - Phone:815-316-1500
Mailing Address - Fax:815-316-1745
Practice Address - Street 1:4141 N ROCKTON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-1593
Practice Address - Country:US
Practice Address - Phone:815-316-1500
Practice Address - Fax:815-316-1745
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041283000163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator