Healthcare Provider Details

I. General information

NPI: 1225354210
Provider Name (Legal Business Name): CARLETTA WHITE STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LOUIS AVE
CINCINNATI OH
45220-2207
US

IV. Provider business mailing address

PO BOX 32023
CINCINNATI OH
45232-0023
US

V. Phone/Fax

Practice location:
  • Phone: 513-559-0665
  • Fax:
Mailing address:
  • Phone: 513-559-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number378511991099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: