Provider Demographics
NPI:1033418256
Name:ANWAR, CAROLYN (LPN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:ANWAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 WASSON ST
Mailing Address - Street 2:
Mailing Address - City:WITHERBEE
Mailing Address - State:NY
Mailing Address - Zip Code:12998-1648
Mailing Address - Country:US
Mailing Address - Phone:518-312-4691
Mailing Address - Fax:
Practice Address - Street 1:33 WASSON ST
Practice Address - Street 2:
Practice Address - City:WITHERBEE
Practice Address - State:NY
Practice Address - Zip Code:12998-1648
Practice Address - Country:US
Practice Address - Phone:518-312-4691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289633-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse