Provider Demographics
NPI:1063068955
Name:MATTMILLER, CARRIE DENISE (LVN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:DENISE
Last Name:MATTMILLER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-4438
Mailing Address - Country:US
Mailing Address - Phone:209-725-1060
Mailing Address - Fax:209-725-1064
Practice Address - Street 1:1343 W MAIN ST STE A&B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4438
Practice Address - Country:US
Practice Address - Phone:209-725-1060
Practice Address - Fax:209-725-1064
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA189332164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse