Provider Demographics
NPI:1417546656
Name:FRIDDLE, CARL LIONEL (RN)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:LIONEL
Last Name:FRIDDLE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-6309
Mailing Address - Country:US
Mailing Address - Phone:432-270-1672
Mailing Address - Fax:
Practice Address - Street 1:2514 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-6309
Practice Address - Country:US
Practice Address - Phone:432-270-1672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX878886163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical