Provider Demographics
NPI:1073245445
Name:BASS-MARTE, CAROLYN LOUISE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LOUISE
Last Name:BASS-MARTE
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 1:6108 HARNESSMAKER CT APT 201
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4831
Mailing Address - Country:US
Mailing Address - Phone:352-875-0659
Mailing Address - Fax:
Practice Address - Street 1:6108 HARNESSMAKER CT APT 201
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4831
Practice Address - Country:US
Practice Address - Phone:352-875-0659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide