Provider Demographics
NPI:1598823544
Name:REGISTER, CARLA J (RN)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:REGISTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 GOLDEN GATE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4725
Mailing Address - Country:US
Mailing Address - Phone:928-753-4288
Mailing Address - Fax:928-753-2303
Practice Address - Street 1:2138 GOLDEN GATE AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4725
Practice Address - Country:US
Practice Address - Phone:928-753-4288
Practice Address - Fax:928-753-2303
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN066476163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse