Individual
MS. CARLY ROSE WIRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, APRN, AGACNP-BC
Contact information
Practice address
305 W JACKSON ST STE 103, CARBONDALE, IL 62901-1474
(618) 351-4972
(618) 351-6522
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209033191
IL
Other
Enumeration date
01/09/2015
Last updated
12/03/2025
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