Provider Demographics
NPI:1992240394
Name:WAIBOER, CAROLYN CARROLL MITCHELL (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN CARROLL
Middle Name:MITCHELL
Last Name:WAIBOER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HALF MILE PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-1500
Mailing Address - Country:US
Mailing Address - Phone:864-901-6788
Mailing Address - Fax:
Practice Address - Street 1:1028 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-1639
Practice Address - Country:US
Practice Address - Phone:864-271-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily