Provider Demographics
NPI:1396064705
Name:NEMNICH, CARRIE L (BS)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:L
Last Name:NEMNICH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4642
Mailing Address - Country:US
Mailing Address - Phone:308-632-1450
Mailing Address - Fax:308-632-1454
Practice Address - Street 1:3707 AVENUE D
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4642
Practice Address - Country:US
Practice Address - Phone:308-632-1450
Practice Address - Fax:308-632-1454
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator