Provider Demographics
NPI:1518667682
Name:CARUANA, JOELLEN
Entity Type:Individual
Prefix:MS
First Name:JOELLEN
Middle Name:
Last Name:CARUANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7794 RIVER MIST CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-6609
Mailing Address - Country:US
Mailing Address - Phone:702-493-2850
Mailing Address - Fax:
Practice Address - Street 1:7794 RIVER MIST CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-6609
Practice Address - Country:US
Practice Address - Phone:702-493-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-5346172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker