Provider Demographics
NPI:1578058160
Name:CARRILLO, IRENE ANNE (BS RN CPN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:ANNE
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:BS RN CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 CLINTON LN
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-7919
Mailing Address - Country:US
Mailing Address - Phone:512-267-3533
Mailing Address - Fax:
Practice Address - Street 1:3800 CLINTON LN
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-7919
Practice Address - Country:US
Practice Address - Phone:512-267-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX559942163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse