Provider Demographics
NPI:1538848510
Name:CARR, CARA CHERIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:CHERIE
Last Name:CARR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CARA
Other - Middle Name:CHERIE
Other - Last Name:DERYCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1892 SHILLING RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-9368
Mailing Address - Country:US
Mailing Address - Phone:585-943-1632
Mailing Address - Fax:
Practice Address - Street 1:1892 SHILLING RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NY
Practice Address - Zip Code:14522-9368
Practice Address - Country:US
Practice Address - Phone:585-943-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340635-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse