Provider Demographics
NPI:1033257845
Name:PROCELL, CAROL LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNN
Last Name:PROCELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:20 OAKBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1424
Mailing Address - Country:US
Mailing Address - Phone:719-542-0271
Mailing Address - Fax:719-583-4439
Practice Address - Street 1:151 CENTRAL MAIN ST
Practice Address - Street 2:PUEBLO CITY-COUNTY HEALTH DEPARTMENT
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4212
Practice Address - Country:US
Practice Address - Phone:719-583-4368
Practice Address - Fax:719-583-4439
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO62394163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75551781Medicaid