Provider Demographics
NPI:1841751062
Name:HORNE, CARLETTA EEDSEL (CNA)
Entity Type:Individual
Prefix:
First Name:CARLETTA
Middle Name:EEDSEL
Last Name:HORNE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3079 S BALDWIN RD STE 1050
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1028
Mailing Address - Country:US
Mailing Address - Phone:248-636-2192
Mailing Address - Fax:
Practice Address - Street 1:3079 S BALDWIN RD STE 1050
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1028
Practice Address - Country:US
Practice Address - Phone:248-636-2192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230015223331110376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI230015223331110OtherCNA LICENSE NUMBER
MI230015223331110OtherCNA LICENSE