Provider Demographics
NPI:1982446886
Name:EMENS, CARRIE LYNN
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:EMENS
Suffix:
Gender:F
Credentials:
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 244
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-0241
Mailing Address - Country:US
Mailing Address - Phone:970-585-4177
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 547
Practice Address - Street 2:
Practice Address - City:DULCE
Practice Address - State:NM
Practice Address - Zip Code:87528-0547
Practice Address - Country:US
Practice Address - Phone:575-759-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1660779163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool