Provider Demographics
NPI:1063616159
Name:CARRIER, VICKI JO (BSN,MSN,CRNFA,ARNP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:JO
Last Name:CARRIER
Suffix:
Gender:F
Credentials:BSN,MSN,CRNFA,ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-652-9555
Mailing Address - Fax:717-791-2621
Practice Address - Street 1:1830 GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1233
Practice Address - Country:US
Practice Address - Phone:717-652-9555
Practice Address - Fax:717-791-2621
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1888442163WR0006X
FLARNP1888442363LF0000X
PASP022218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5248OtherBLUE CROSS BLUE SHIELD