Healthcare Provider Details

I. General information

NPI: 1780113522
Provider Name (Legal Business Name): CARLA STAR NOE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SC DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL 2100 BULL STREET
COLLUMBIA SC
29204
US

IV. Provider business mailing address

309 HANCOCK RD
AIKEN SC
29801-0647
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-0664
  • Fax:
Mailing address:
  • Phone: 803-507-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number91178
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: