Provider Demographics
NPI:1598371346
Name:BRENTS, CAROLYN LAJOYCE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LAJOYCE
Last Name:BRENTS
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 1:807 SLONE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-2459
Mailing Address - Country:US
Mailing Address - Phone:903-742-1919
Mailing Address - Fax:
Practice Address - Street 1:807 SLONE DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-2459
Practice Address - Country:US
Practice Address - Phone:903-742-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183544164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse