Healthcare Provider Details

I. General information

NPI: 1730135872
Provider Name (Legal Business Name): RENEE LOMAN CARROLL R.N., N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 ACORN TRL
HORTON MI
49246-9757
US

IV. Provider business mailing address

551 ACORN TRL
HORTON MI
49246-9757
US

V. Phone/Fax

Practice location:
  • Phone: 517-688-4984
  • Fax:
Mailing address:
  • Phone: 517-688-4984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704088134
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: