Provider Demographics
NPI:1215297858
Name:FACEY, CARLA KAREN (LPN)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:KAREN
Last Name:FACEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:KAREN
Other - Last Name:LITTREAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 FALSTAFF RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-5543
Mailing Address - Country:US
Mailing Address - Phone:585-305-0801
Mailing Address - Fax:
Practice Address - Street 1:100 FALSTAFF ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-1884
Practice Address - Country:US
Practice Address - Phone:585-305-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284396-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1215297858Medicaid