Provider Demographics
NPI:1811291636
Name:LA TORRE, CAROL LYNN (NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:LA TORRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:704-978-3549
Practice Address - Street 1:700 SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3440
Practice Address - Country:US
Practice Address - Phone:704-924-9111
Practice Address - Fax:704-883-0452
Is Sole Proprietor?:No
Enumeration Date:2011-01-08
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5005033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC4011AMedicare PIN
NC2595156Medicare PIN