Provider Demographics
NPI:1518349943
Name:WADMAN, CARRIE (MA, CRC, ADS)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:WADMAN
Suffix:
Gender:F
Credentials:MA, CRC, ADS
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:HAGEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CRC, ADS
Mailing Address - Street 1:1825 KNOB RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-9450
Mailing Address - Country:US
Mailing Address - Phone:813-541-0145
Mailing Address - Fax:
Practice Address - Street 1:1501 BOYD ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-4802
Practice Address - Country:US
Practice Address - Phone:813-541-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACU0000000279171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist