Healthcare Provider Details

I. General information

NPI: 1982906897
Provider Name (Legal Business Name): JUDITH M CARMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH M CARROLL

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 10/23/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER BOULEVARD
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

440 MOORES MILL ROAD
RIDGEWAY VA
24148
US

V. Phone/Fax

Practice location:
  • Phone: 210-237-0407
  • Fax:
Mailing address:
  • Phone: 480-353-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001303560
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: