Provider Demographics
NPI:1487925657
Name:EDICK, CARROLL ANNE (RN)
Entity type:Individual
Prefix:
First Name:CARROLL
Middle Name:ANNE
Last Name:EDICK
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 1:1001 RUBY ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2565
Mailing Address - Country:US
Mailing Address - Phone:315-338-5374
Mailing Address - Fax:315-334-7528
Practice Address - Street 1:1001 RUBY ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2565
Practice Address - Country:US
Practice Address - Phone:315-338-5374
Practice Address - Fax:315-334-7528
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY563115-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool