Individual
TINA MARIE CARR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1884 CLARK RD, ENON VALLEY, PA 16120-3512
(330) 610-5757
Mailing address
1884 CLARK RD, ENON VALLEY, PA 16120-3512
(330) 610-5757
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.102218
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2670275
PRIVATE PROVIDER
OH
Enumeration date
01/09/2007
Last updated
07/08/2007
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