Provider Demographics
NPI:1598039588
Name:CARROTT, AUDREY DEBORAH (RN)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:DEBORAH
Last Name:CARROTT
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 1:7002 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1745
Mailing Address - Country:US
Mailing Address - Phone:718-396-2602
Mailing Address - Fax:718-429-5162
Practice Address - Street 1:7002 54TH AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1745
Practice Address - Country:US
Practice Address - Phone:718-396-2602
Practice Address - Fax:718-429-5162
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22461297163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool