Healthcare Provider Details

I. General information

NPI: 1194783431
Provider Name (Legal Business Name): CAROLYN ELAINE MAYS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 WEST LEMON HILL RD NW
MCCONNELSVILLE OH
43756-9685
US

IV. Provider business mailing address

6001 WEST LEMON HILL RD NW
MCCONNELSVILLE OH
43756-9685
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-9937
  • Fax:
Mailing address:
  • Phone: 740-962-9937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN075129
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: