Provider Demographics
NPI:1659413573
Name:CARROLL, JENNIFER DEANN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DEANN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RN, BSN
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 839
Mailing Address - Street 2:
Mailing Address - City:PINON
Mailing Address - State:AZ
Mailing Address - Zip Code:86510
Mailing Address - Country:US
Mailing Address - Phone:928-725-2214
Mailing Address - Fax:928-725-2216
Practice Address - Street 1:1 MILE N OF PINON ON NAVAJO RTE 41
Practice Address - Street 2:
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-725-2214
Practice Address - Fax:928-725-2216
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN141280163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse