Provider Demographics
NPI:1033396619
Name:TAULBEE, CAROLYN SUE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:TAULBEE
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 1:360 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-1316
Mailing Address - Country:US
Mailing Address - Phone:740-380-6362
Mailing Address - Fax:
Practice Address - Street 1:360 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1316
Practice Address - Country:US
Practice Address - Phone:740-380-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400588220207376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2732476Medicaid