Provider Demographics
NPI:1003495698
Name:ATTANASIO, CARMEN IV (RN)
Entity Type:Individual
Prefix:MR
First Name:CARMEN
Middle Name:
Last Name:ATTANASIO
Suffix:IV
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 COURTDALE AVE
Mailing Address - Street 2:
Mailing Address - City:COURTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1137
Mailing Address - Country:US
Mailing Address - Phone:570-301-3045
Mailing Address - Fax:
Practice Address - Street 1:25 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3507
Practice Address - Country:US
Practice Address - Phone:570-808-2514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN566631163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse