Provider Demographics
NPI:1477699106
Name:ALDRIDGE, CAROL LYNNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNNE
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 PINE MANOR BLVD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4840
Mailing Address - Country:US
Mailing Address - Phone:614-875-6379
Mailing Address - Fax:
Practice Address - Street 1:3142 PINE MANOR BLVD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4840
Practice Address - Country:US
Practice Address - Phone:614-875-6379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN288764163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2190936Medicaid