Provider Demographics
NPI:1609176254
Name:METZGER, CARL S (BSN, RN)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:S
Last Name:METZGER
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 CARROLL CAVE RD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-6370
Mailing Address - Country:US
Mailing Address - Phone:573-596-0131
Mailing Address - Fax:573-596-0168
Practice Address - Street 1:126 MISSOURI AVE
Practice Address - Street 2:GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8952
Practice Address - Country:US
Practice Address - Phone:573-596-0131
Practice Address - Fax:573-596-0168
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152804163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management