Provider Demographics
NPI:1114414281
Name:CARR, CLARE COLLEEN (RN)
Entity type:Individual
Prefix:MS
First Name:CLARE
Middle Name:COLLEEN
Last Name:CARR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 47TH ST S UNIT D
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-3988
Mailing Address - Country:US
Mailing Address - Phone:701-541-6726
Mailing Address - Fax:
Practice Address - Street 1:3601 12TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-8100
Practice Address - Country:US
Practice Address - Phone:218-284-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR45244163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse