Individual
SAM CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
12047 LAKE AVE, LAKEWOOD, OH 44107-1891
(216) 228-0158
Mailing address
12047 LAKE AVE, LAKEWOOD, OH 44107-1891
(216) 228-0158
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
PN091042
OH
Other
Enumeration date
05/26/2010
Last updated
05/26/2010
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