Provider Demographics
NPI:1356139547
Name:SORRELLS, CAROLANN LAVON (STNA)
Entity type:Individual
Prefix:
First Name:CAROLANN
Middle Name:LAVON
Last Name:SORRELLS
Suffix:
Gender:
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 TELFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-1156
Mailing Address - Country:US
Mailing Address - Phone:313-920-7879
Mailing Address - Fax:
Practice Address - Street 1:1314 TELFORD AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-1156
Practice Address - Country:US
Practice Address - Phone:313-920-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602340060323376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide