Provider Demographics
NPI:1841433273
Name:WHALEN, CARRIE JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JO
Last Name:WHALEN
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 1:77 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-1601
Mailing Address - Country:US
Mailing Address - Phone:740-277-5769
Mailing Address - Fax:
Practice Address - Street 1:77 N HIGH ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1601
Practice Address - Country:US
Practice Address - Phone:740-277-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112624164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse