Provider Demographics
NPI:1306536925
Name:SILVA, CARRIE (CNIM, REEGT, RPSGT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:SILVA
Suffix:
Gender:F
Credentials:CNIM, REEGT, RPSGT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:UTKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1110 YELLOWSTONE AVE # 191
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4312
Mailing Address - Country:US
Mailing Address - Phone:208-305-1233
Mailing Address - Fax:
Practice Address - Street 1:246 N CURLEW DR APT 9301
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83401-1530
Practice Address - Country:US
Practice Address - Phone:208-305-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
7256246ZE0500X
5050246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG