Provider Demographics
NPI:1326197427
Name:THEISS, CARRIE ELLEN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ELLEN
Last Name:THEISS
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 1:2501 OAKINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN PROVING GROUND
Mailing Address - State:MD
Mailing Address - Zip Code:21005-5131
Mailing Address - Country:US
Mailing Address - Phone:410-278-1928
Mailing Address - Fax:410-278-1944
Practice Address - Street 1:2501 OAKINGTON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21005-5131
Practice Address - Country:US
Practice Address - Phone:410-278-1928
Practice Address - Fax:410-278-1944
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05500300164W00000X
TX189425164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Not Answered164X00000XNursing Service ProvidersLicensed Vocational Nurse