Provider Demographics
NPI:1417629569
Name:BAKULA, CARRI L (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CARRI
Middle Name:L
Last Name:BAKULA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84055-0343
Mailing Address - Country:US
Mailing Address - Phone:435-640-5252
Mailing Address - Fax:435-783-5336
Practice Address - Street 1:4246 N MEADOW LANE
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:UT
Practice Address - Zip Code:84055
Practice Address - Country:US
Practice Address - Phone:435-640-5252
Practice Address - Fax:435-783-5336
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT320313-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse