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Individual
MRS. E JESSICA LYNN CARROLL
Active
Individual
MRS. E JESSICA LYNN CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN260396L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PN260396L
PRACTICAL NURSE
PA
Enumeration date
05/08/2007
Last updated
06/13/2008
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