Provider Demographics
NPI:1104351485
Name:NEAL, CARLDTTA
Entity type:Individual
Prefix:
First Name:CARLDTTA
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 FENMORE LN
Mailing Address - Street 2:
Mailing Address - City:REMINDERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3206 FENMORE LN
Practice Address - Street 2:
Practice Address - City:REMINDERVILLE
Practice Address - State:OH
Practice Address - Zip Code:44202-8183
Practice Address - Country:US
Practice Address - Phone:133-034-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide