Provider Demographics
NPI:1104013986
Name:UNDERWOOD, CARLA J (RN)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:J
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SUGARTREE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3024
Mailing Address - Country:US
Mailing Address - Phone:615-500-4750
Mailing Address - Fax:
Practice Address - Street 1:3718 NOLENSVILLE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3302
Practice Address - Country:US
Practice Address - Phone:615-880-2138
Practice Address - Fax:615-862-4012
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000108612163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse