Provider Demographics
NPI:1184977001
Name:KEMP, CAROLYN RENAE
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:RENAE
Last Name:KEMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 BROWNSTONE BLVD
Mailing Address - Street 2:#903
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614
Mailing Address - Country:US
Mailing Address - Phone:419-789-9048
Mailing Address - Fax:
Practice Address - Street 1:1817 BROWNSTONE BLVD
Practice Address - Street 2:#903
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-6305
Practice Address - Country:US
Practice Address - Phone:419-789-9048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.N.-IV127648164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse