Provider Demographics
NPI:1710107156
Name:CARTER, LILLIAN DIANE (CNA)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:DIANE
Last Name:CARTER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 E FULTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2533
Mailing Address - Country:US
Mailing Address - Phone:614-253-8027
Mailing Address - Fax:614-253-8027
Practice Address - Street 1:1621 E FULTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2533
Practice Address - Country:US
Practice Address - Phone:614-253-8027
Practice Address - Fax:614-253-8027
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3651660376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3651660OtherCERTIFIED NURSE AIDE