Provider Demographics
NPI:1033519475
Name:CARROLL, JOY (LPN)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E8485 HWY 136
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WI
Mailing Address - Zip Code:53961-9708
Mailing Address - Country:US
Mailing Address - Phone:608-381-1434
Mailing Address - Fax:608-522-4585
Practice Address - Street 1:E8485 HWY 136
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WI
Practice Address - Zip Code:53961-9708
Practice Address - Country:US
Practice Address - Phone:608-381-1434
Practice Address - Fax:608-522-4585
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309708-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse