Provider Demographics
NPI:1588148423
Name:TANG, CARRIE ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANN
Last Name:TANG
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 1:478 MAJESKIE DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-6533
Mailing Address - Country:US
Mailing Address - Phone:262-352-2506
Mailing Address - Fax:
Practice Address - Street 1:415 BLACK EARTH RD
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9759
Practice Address - Country:US
Practice Address - Phone:262-968-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI112695163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse