Provider Demographics
NPI:1235740770
Name:DRAKE, CARRIE A (RN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:DRAKE
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 1:508 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-7423
Mailing Address - Country:US
Mailing Address - Phone:610-451-8365
Mailing Address - Fax:
Practice Address - Street 1:17 HAYS AVE
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:NY
Practice Address - Zip Code:13795-1418
Practice Address - Country:US
Practice Address - Phone:607-761-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY665143163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse