Provider Demographics
NPI:1033998604
Name:BLOCK, CARRIE (LSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2476 MAUTZ YEAGER RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-8720
Mailing Address - Country:US
Mailing Address - Phone:740-225-9064
Mailing Address - Fax:
Practice Address - Street 1:2476 MAUTZ YEAGER RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-8720
Practice Address - Country:US
Practice Address - Phone:740-225-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty