Provider Demographics
NPI:1134764863
Name:CARLTON, RENEE (LPN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:CARLTON
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 1:3311 POLKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-8682
Mailing Address - Country:US
Mailing Address - Phone:704-473-3206
Mailing Address - Fax:
Practice Address - Street 1:3311 POLKVILLE RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-8682
Practice Address - Country:US
Practice Address - Phone:704-473-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78815164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse