Healthcare Provider Details

I. General information

NPI: 1710107156
Provider Name (Legal Business Name): LILLIAN DIANE CARTER CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 E FULTON ST
COLUMBUS OH
43205-2533
US

IV. Provider business mailing address

1621 E FULTON ST
COLUMBUS OH
43205-2533
US

V. Phone/Fax

Practice location:
  • Phone: 614-253-8027
  • Fax: 614-253-8027
Mailing address:
  • Phone: 614-253-8027
  • Fax: 614-253-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number3651660
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: