Provider Demographics
NPI:1710569173
Name:ROSE, CARLIE NUNN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:CARLIE
Middle Name:NUNN
Last Name:ROSE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:LANE
Other - Last Name:NUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13601 PRESTON RD STE 210W
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4986
Mailing Address - Country:US
Mailing Address - Phone:972-702-0300
Mailing Address - Fax:
Practice Address - Street 1:13601 PRESTON RD STE 210W
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4986
Practice Address - Country:US
Practice Address - Phone:972-702-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1009689164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse