Provider Demographics
NPI:1649802422
Name:WOLDEAB, CARRIE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:WOLDEAB
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9451 N 84TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1836
Mailing Address - Country:US
Mailing Address - Phone:480-484-1111
Mailing Address - Fax:
Practice Address - Street 1:9451 N 84TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1836
Practice Address - Country:US
Practice Address - Phone:480-484-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN169053163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool