Provider Demographics
NPI:1437434354
Name:CARVER FAMILY HEALTH, LLC
Entity Type:Organization
Organization Name:CARVER FAMILY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CORRIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:307-789-8721
Mailing Address - Street 1:196 ARROWHEAD DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-8752
Mailing Address - Country:US
Mailing Address - Phone:307-789-8721
Mailing Address - Fax:307-789-8664
Practice Address - Street 1:196 ARROWHEAD DR
Practice Address - Street 2:SUITE #4
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-8752
Practice Address - Country:US
Practice Address - Phone:307-789-8721
Practice Address - Fax:307-789-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY21231-1125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty