Individual
MRS. JAMIE HULTGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1237 E MAIN ST STE C1, CARBONDALE, IL 62901-3148
(618) 457-2281
(618) 529-0573
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.385120
IL
363L00000X
Nurse Practitioner
Primary
209020583
IL
Other
Enumeration date
11/22/2019
Last updated
07/13/2021
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