Provider Demographics
NPI:1568102382
Name:PRICE, CARLICIA LA JOYCE
Entity Type:Individual
Prefix:MISS
First Name:CARLICIA
Middle Name:LA JOYCE
Last Name:PRICE
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:PO BOX 16267
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-0267
Mailing Address - Country:US
Mailing Address - Phone:314-369-4882
Mailing Address - Fax:
Practice Address - Street 1:3638 N 40TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-3421
Practice Address - Country:US
Practice Address - Phone:314-369-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide