Provider Demographics
NPI:1003245309
Name:VANATTA, CARRIE LORRAINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LORRAINE
Last Name:VANATTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:CARRIE
Other - Middle Name:LORRAINE
Other - Last Name:GOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:46685 TOWNSHIP ROAD 74
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-8914
Mailing Address - Country:US
Mailing Address - Phone:740-294-4912
Mailing Address - Fax:
Practice Address - Street 1:46685 TOWNSHIP ROAD 74
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-8914
Practice Address - Country:US
Practice Address - Phone:740-294-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144253164W00000X
OH436161163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse