Provider Demographics
NPI:1023253952
Name:ORSBURN, CARLY AMBER (CST/CFA)
Entity type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:AMBER
Last Name:ORSBURN
Suffix:
Gender:F
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7811 HIGHWAY 12 E
Mailing Address - Street 2:
Mailing Address - City:STEENS
Mailing Address - State:MS
Mailing Address - Zip Code:39766-9012
Mailing Address - Country:US
Mailing Address - Phone:662-312-9734
Mailing Address - Fax:
Practice Address - Street 1:7811 HIGHWAY 12 E
Practice Address - Street 2:
Practice Address - City:STEENS
Practice Address - State:MS
Practice Address - Zip Code:39766-9012
Practice Address - Country:US
Practice Address - Phone:662-312-9734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS103306246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant