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NPI Code Detail

MEDICARE: LETHEDA CARROLL

MEDICARE: LETHEDA CARROLL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse734980NY
2164W00000XLicensed Practical Nurse278773NY

General Provider Information

NPI Number : 1881122299
Entity Type Code : Individual
Provider Name (Legal Business Name) : LETHEDA CARROLL
Provider Business Mailing Address
First Line : 1216 BAY ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3169
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1216 BAY ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3169
Country : US
Telephone Number : 718-982-4779
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2017
Last Update Date : 11/21/2024

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Directions to “ LETHEDA CARROLL ” Practice Location

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