Provider Demographics
NPI:1649646530
Name:POLSTON, CARLA CLEWIS (RN)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:CLEWIS
Last Name:POLSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CARLA
Other - Middle Name:DAWN
Other - Last Name:CLEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ETC
Mailing Address - Street 1:11561 HOOPER DR
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-7745
Mailing Address - Country:US
Mailing Address - Phone:910-276-9176
Mailing Address - Fax:
Practice Address - Street 1:11561 HOOPER DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-7745
Practice Address - Country:US
Practice Address - Phone:910-276-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC$$$$$$$$$OtherSS $$$$$$$$$