Provider Demographics
NPI:1184847774
Name:CARROLL, MARILYN J (RN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:CARROLL
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 1:330 PAGEANT LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3854
Mailing Address - Country:US
Mailing Address - Phone:931-648-5747
Mailing Address - Fax:931-645-9019
Practice Address - Street 1:330 PAGEANT LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3854
Practice Address - Country:US
Practice Address - Phone:931-648-5747
Practice Address - Fax:931-645-9019
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96660163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN96660OtherRN