Provider Demographics
NPI:1558589820
Name:CARSON, PATRICIA JEANNE (RNC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEANNE
Last Name:CARSON
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9624 BANES ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3104
Mailing Address - Country:US
Mailing Address - Phone:215-464-6941
Mailing Address - Fax:
Practice Address - Street 1:4300 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19124-3926
Practice Address - Country:US
Practice Address - Phone:215-831-2086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA184816L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse