Provider Demographics
NPI:1326674664
Name:RICANEK-CLINTON, CARMEN J (DOULA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:J
Last Name:RICANEK-CLINTON
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SAINT ANDREWS DR APT A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-8372
Mailing Address - Country:US
Mailing Address - Phone:910-398-4981
Mailing Address - Fax:
Practice Address - Street 1:820 SAINT ANDREWS DR APT A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-8372
Practice Address - Country:US
Practice Address - Phone:910-398-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN