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NPI Code Detail

MEDICARE: MARILYN J. CARROLL RN

MEDICARE: MARILYN J. CARROLL RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse96660TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
196660OTHERTNRN

General Provider Information

NPI Number : 1184847774
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN J. CARROLL RN
Provider Business Mailing Address
First Line : 330 PAGEANT LN
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37040-3854
Country : US
Telephone Number : 931-648-5747
Fax Number : 931-645-9019
Provider Business Practice Location Address
First Line : 330 PAGEANT LN
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37040-3854
Country : US
Telephone Number : 931-648-5747
Fax Number : 931-645-9019
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2007
Last Update Date : 07/08/2007

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