Provider Demographics
NPI:1649633603
Name:BARRETT, CARRIE ANNE (LPN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANNE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:CARRIE
Other - Middle Name:ANNE
Other - Last Name:WILLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4495 BENNETTS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14470-9502
Mailing Address - Country:US
Mailing Address - Phone:585-638-5393
Mailing Address - Fax:
Practice Address - Street 1:300 CRANBERRY LANDING DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-2984
Practice Address - Country:US
Practice Address - Phone:585-244-3630
Practice Address - Fax:585-288-3739
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283038164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse