| Doctor Name: | CAROL MAIN-BENNER |
| NPI Number: | 1366453698 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 209-003422 |
| Business Practice Address: | 912 Northwest Hwy Suite 7- Attn Raylene Boyd Fox River Grove, IL - 600211925 |
| Business Phone Number: | 8478291600 |
| Business Fax Number: | |
| Mailing Address: | 1919 S Highland Ave, #b202-attn Raylene Boyd LOMBARD |
| State: | IL |
| Postal Code: | 601486153 |
| Phone Number: | 6308737305 |
| Fax Number: | |
| NPI Enumeration Date: | 08/11/2006 |
| NPI Last Update Date: | 11/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 209-003422 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |