Provider Demographics
NPI:1003410911
Name:GARRETSON, CAROLYN LOUISE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LOUISE
Last Name:GARRETSON
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 1:3200 JERICO RD
Mailing Address - Street 2:
Mailing Address - City:MARLINTON
Mailing Address - State:WV
Mailing Address - Zip Code:24954-6802
Mailing Address - Country:US
Mailing Address - Phone:304-799-3995
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:8 N SPRING ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2720
Practice Address - Country:US
Practice Address - Phone:304-472-0395
Practice Address - Fax:304-471-2488
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker