Provider Demographics
NPI:1790067999
Name:CARVER, CORRIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:CARVER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 OVERTHRUST RD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-9261
Mailing Address - Country:US
Mailing Address - Phone:307-789-8721
Mailing Address - Fax:307-789-8664
Practice Address - Street 1:191 OVERTHRUST RD
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9261
Practice Address - Country:US
Practice Address - Phone:307-789-8721
Practice Address - Fax:307-789-8664
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY21231.1125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily