Provider Demographics
NPI:1285374603
Name:EXTON, CAROL REGINA
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:REGINA
Last Name:EXTON
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 1:2248 WILDING AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3245
Mailing Address - Country:US
Mailing Address - Phone:678-206-9570
Mailing Address - Fax:
Practice Address - Street 1:2248 WILDING AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3245
Practice Address - Country:US
Practice Address - Phone:678-206-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care