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General NPI Number Information
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NPI Number | 1659413573
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Entity Type | Individual
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Provider Name | JENNIFER DEANN CARROLL R.N., B.S.N.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 MILE N OF PINON ON NAVAJO RTE 41
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City | PINON
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State | AZ
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Zip | 86510
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Country | US
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Telephone | 928-725-2214
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Fax | 928-725-2216
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Provider Business Mailing Address
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Address Line | PO BOX 839
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City | PINON
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State | AZ
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Zip | 86510
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Country | US
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Telephone | 928-725-2214
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Fax | 928-725-2216
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN141280
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License Number State | AZ
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