Individual
CARLY LOUISE VORMEZEELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3535 N BELL SCHOOL RD, ROCKFORD, IL 61114-6624
(779) 696-9400
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.006927
IL
Other
Enumeration date
02/11/2019
Last updated
03/03/2021
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