Provider Demographics
NPI:1710256508
Name:CANTLEBERRY, CAROL (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CANTLEBERRY
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 1:19021 FREEPORT ST NW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1278
Mailing Address - Country:US
Mailing Address - Phone:763-633-3800
Mailing Address - Fax:763-633-3800
Practice Address - Street 1:19021 FREEPORT ST NW
Practice Address - Street 2:SUITE 400
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1278
Practice Address - Country:US
Practice Address - Phone:763-633-3800
Practice Address - Fax:763-633-3800
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health