Provider Demographics
NPI:1154628782
Name:BARE, CAROL A (LPN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:BARE
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 1:7695 DELAWARE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7014
Mailing Address - Country:US
Mailing Address - Phone:440-243-2402
Mailing Address - Fax:440-243-2402
Practice Address - Street 1:7695 DELAWARE DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7014
Practice Address - Country:US
Practice Address - Phone:440-243-2402
Practice Address - Fax:440-243-2402
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.063232-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse