Provider Demographics
NPI:1871192138
Name:LUMLEY, CARLY (RN)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:LUMLEY
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:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-0371
Mailing Address - Country:US
Mailing Address - Phone:701-313-0229
Mailing Address - Fax:
Practice Address - Street 1:209 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-4400
Practice Address - Country:US
Practice Address - Phone:701-313-0229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1472287Medicaid