Individual
COURTNEY NICOLLE FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, FNP-C, FPA
Contact information
Practice address
2823 GLENWOOD AVE, ROCKFORD, IL 61101
(815) 968-5342
(815) 968-4656
Mailing address
7080 MILL RD, ROCKFORD, IL 61108-2623
(815) 209-8486
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
227.004073
IL
363LF0000X
Family Nurse Practitioner
209014910
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
277004073
IL
Other
Enumeration date
08/31/2016
Last updated
03/30/2026
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