Provider Demographics
NPI:1801009501
Name:CARROLL, E JESSICA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:E JESSICA
Middle Name:LYNN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 N STATE ROUTE 934
Mailing Address - Street 2:APT 3
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-8932
Mailing Address - Country:US
Mailing Address - Phone:717-644-2585
Mailing Address - Fax:
Practice Address - Street 1:1577 N STATE ROUTE 934
Practice Address - Street 2:APT 3
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-8932
Practice Address - Country:US
Practice Address - Phone:717-644-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN260396L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPN260396LOtherPRACTICAL NURSE