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General NPI Number Information
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NPI Number | 1467611426
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Entity Type | Individual
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Provider Name | CARLA S TATE RN
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Gender | Female
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 28820 CHAGRIN BLVD APT.216
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City | WOODMERE
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State | OH
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Zip | 44122-4641
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Country | US
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Telephone | 216-772-7725
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Fax |
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Provider Business Mailing Address
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Address Line | 28820 CHAGRIN BLVD APT 219
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City | WOODMERE
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State | OH
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Zip | 44122-4641
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Country | US
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Telephone | 216-772-7725
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | RH042828
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 340388
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License Number State | OH
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