Provider Demographics
NPI:1043768906
Name:DIMIRIS, CARLA (APRN PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:DIMIRIS
Suffix:
Gender:F
Credentials:APRN PMHNP-BC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:HUNT
Other - Last Name:DIMIRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN PMHNP-BC
Mailing Address - Street 1:400 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3405
Mailing Address - Country:US
Mailing Address - Phone:443-526-6133
Mailing Address - Fax:443-526-6134
Practice Address - Street 1:400 LEWIS ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3405
Practice Address - Country:US
Practice Address - Phone:443-526-6133
Practice Address - Fax:443-526-6134
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0000144363LP0808X
MDAN-0011791363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health