Provider Demographics
NPI:1013045681
Name:HETTICH, CARROLYN JEAN
Entity Type:Individual
Prefix:MS
First Name:CARROLYN
Middle Name:JEAN
Last Name:HETTICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARROLYN
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1226 AMARILLO ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-3504
Mailing Address - Country:US
Mailing Address - Phone:325-677-5595
Mailing Address - Fax:
Practice Address - Street 1:1226 AMARILLO ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-3504
Practice Address - Country:US
Practice Address - Phone:325-677-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion