Provider Demographics
NPI:1588288401
Name:CARMAN, MILDRED ALEXANDRIA (LPN)
Entity type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:ALEXANDRIA
Last Name:CARMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-0198
Mailing Address - Country:US
Mailing Address - Phone:631-644-9021
Mailing Address - Fax:
Practice Address - Street 1:7 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4164
Practice Address - Country:US
Practice Address - Phone:631-644-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336955-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse