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General NPI Number Information
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NPI Number | 1053079640
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Entity Type | Individual
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Provider Name | KALI MARIE CARLISLE MSN, APRN, CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 2219 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44483-6105
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Country | US
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Telephone | 330-507-9545
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Fax |
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Provider Business Mailing Address
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Address Line | 47271 METZ RD
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City | NEW WATERFORD
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State | OH
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Zip | 44445-9720
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Country | US
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Telephone | 330-507-9545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN.CNP0029692
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License Number State | OH
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