Provider Demographics
NPI:1760617948
Name:CARLYLE, NANCY JEAN (RN)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JEAN
Last Name:CARLYLE
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 1:15 AZTEC AVE.
Mailing Address - Street 2:
Mailing Address - City:FOREST KNOLLS
Mailing Address - State:CA
Mailing Address - Zip Code:94933-0783
Mailing Address - Country:US
Mailing Address - Phone:415-488-0167
Mailing Address - Fax:
Practice Address - Street 1:15 AZTEC AVE.
Practice Address - Street 2:
Practice Address - City:FOREST KNOLLS
Practice Address - State:CA
Practice Address - Zip Code:94933-0783
Practice Address - Country:US
Practice Address - Phone:415-488-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA706146163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse