Provider Demographics
NPI:1912243239
Name:CARLE, LERINDA KAY (IDMT)
Entity type:Individual
Prefix:
First Name:LERINDA
Middle Name:KAY
Last Name:CARLE
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6676 MYRTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80927-4034
Mailing Address - Country:US
Mailing Address - Phone:910-494-8196
Mailing Address - Fax:
Practice Address - Street 1:6676 MYRTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80927-4034
Practice Address - Country:US
Practice Address - Phone:910-494-8196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians