Provider Demographics
NPI:1386049526
Name:CARROLL, YASMINA (CNA)
Entity type:Individual
Prefix:
First Name:YASMINA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7939 W CONGRESS ST
Mailing Address - Street 2:LOWER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4525
Mailing Address - Country:US
Mailing Address - Phone:414-544-9747
Mailing Address - Fax:
Practice Address - Street 1:7939 W CONGRESS ST
Practice Address - Street 2:LOWER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4525
Practice Address - Country:US
Practice Address - Phone:414-544-9747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI218266174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator