Provider Demographics
NPI:1558537324
Name:SQUARE, CAROLYN DENISE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:DENISE
Last Name:SQUARE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WIRT BLVD # 4
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1530
Mailing Address - Country:US
Mailing Address - Phone:330-743-0883
Mailing Address - Fax:
Practice Address - Street 1:127 WIRT BLVD # 4
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1530
Practice Address - Country:US
Practice Address - Phone:330-743-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.127857 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse