Provider Demographics
NPI:1881021780
Name:CAROL DOUGLASS RN
Entity Type:Organization
Organization Name:CAROL DOUGLASS RN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:413-695-9436
Mailing Address - Street 1:106 SEARS RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:MA
Mailing Address - Zip Code:01032-9607
Mailing Address - Country:US
Mailing Address - Phone:413-695-9436
Mailing Address - Fax:
Practice Address - Street 1:106 SEARS RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:MA
Practice Address - Zip Code:01032-9607
Practice Address - Country:US
Practice Address - Phone:413-695-9436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN259384163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty