Provider Demographics
NPI:1487920476
Name:UMPLEBY, CARMA C
Entity type:Individual
Prefix:MRS
First Name:CARMA
Middle Name:C
Last Name:UMPLEBY
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:STEPHEN
Other - Middle Name:S
Other - Last Name:UMPLEBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2642 E WILLETTA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4613
Mailing Address - Country:US
Mailing Address - Phone:801-668-4167
Mailing Address - Fax:
Practice Address - Street 1:2642 E WILLETTA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4613
Practice Address - Country:US
Practice Address - Phone:801-668-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-24
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35166533747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant