Provider Demographics
NPI:1396160065
Name:CARBONARO, GLYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:GLYNN
Middle Name:
Last Name:CARBONARO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BEACH 127TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1726
Mailing Address - Country:US
Mailing Address - Phone:646-496-3179
Mailing Address - Fax:
Practice Address - Street 1:745 BEACH 79TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11692
Practice Address - Country:US
Practice Address - Phone:718-474-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334071-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool