Provider Demographics
NPI:1780113522
Name:NOE, CARLA STAR (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:STAR
Last Name:NOE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 HANCOCK RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-0647
Mailing Address - Country:US
Mailing Address - Phone:803-507-8991
Mailing Address - Fax:
Practice Address - Street 1:SC DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Practice Address - Street 2:2100 BULL STREET
Practice Address - City:COLLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-898-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91178163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse