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Contact Information

COURTNEY N FORMAN, PMHNP-BC, FNP-C, FPA
2823 GLENWOOD AVE
ROCKFORD, IL61101
 Phone: 815-968-5342
 Fax: 815-968-4656
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Family

363LF0000X 50 Nurse Practitioner
 

Psychiatric/Mental Health

363LP0808X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for COURTNEY N FORMAN · (Female)

NPI Number 1376099127
Status Active
Credentials PMHNP-BC, FNP-C, FPA
Entity Individual
Enumeration date 08/31/2016
Last updated 03/30/2026 - About 2 months ago
Sole proprietor 1 No
Identifiers
  • IL License # 209014910
  • IL License # 227.004073
  • IL License # 277004073
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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