Provider Demographics
NPI:1255389086
Name:CARROLL, LIDIA LOURDES (RT)
Entity type:Individual
Prefix:MRS
First Name:LIDIA
Middle Name:LOURDES
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RT
Other - Prefix:MRS
Other - First Name:LIDIA
Other - Middle Name:LOURDES
Other - Last Name:LUGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:108 LIVE OAK DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8236
Mailing Address - Country:US
Mailing Address - Phone:910-904-1732
Mailing Address - Fax:
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:910-482-5174
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-41682278C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedCritical Care