Provider Demographics
NPI:1215393004
Name:BACKER, CAROLINE NANCY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:NANCY
Last Name:BACKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:CAROLINE
Other - Middle Name:NANCY
Other - Last Name:HULBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4128 STATE ROUTE 36
Mailing Address - Street 2:
Mailing Address - City:CANISTEO
Mailing Address - State:NY
Mailing Address - Zip Code:14823-9653
Mailing Address - Country:US
Mailing Address - Phone:607-368-2826
Mailing Address - Fax:
Practice Address - Street 1:4128 STATE ROUTE 36
Practice Address - Street 2:
Practice Address - City:CANISTEO
Practice Address - State:NY
Practice Address - Zip Code:14823-9653
Practice Address - Country:US
Practice Address - Phone:607-368-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152993-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse