Provider Demographics
NPI:1649793506
Name:ROTHMANN, CARLA RAE (NP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:RAE
Last Name:ROTHMANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5900
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:PO BOX 916
Practice Address - Street 2:
Practice Address - City:DELTAVILLE
Practice Address - State:VA
Practice Address - Zip Code:23043-0916
Practice Address - Country:US
Practice Address - Phone:804-776-8000
Practice Address - Fax:804-776-6211
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024175046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily