Provider Demographics
NPI:1366951790
Name:WIGHT, CARLY OLIVIA (RN)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:OLIVIA
Last Name:WIGHT
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 1:112 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7428
Mailing Address - Country:US
Mailing Address - Phone:207-323-4716
Mailing Address - Fax:
Practice Address - Street 1:112 WOODS RD
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7428
Practice Address - Country:US
Practice Address - Phone:207-323-4716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN62873163WH1000X, 163WP0808X, 163WS0200X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool