Provider Demographics
NPI:1831181221
Name:ZARA, CAROLYN SUE (CRNP, CNS, IBCLC)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:SUE
Last Name:ZARA
Suffix:
Gender:F
Credentials:CRNP, CNS, IBCLC
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:SUE
Other - Last Name:ZARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP, CNS, IBCLC
Mailing Address - Street 1:120 STURGES AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2399
Mailing Address - Country:US
Mailing Address - Phone:419-525-4620
Mailing Address - Fax:419-525-4620
Practice Address - Street 1:120 STURGES AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2399
Practice Address - Country:US
Practice Address - Phone:419-525-4620
Practice Address - Fax:419-525-4620
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-04736363LP0200X, 363LW0102X
OHNS-04519364SP0200X, 364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Not Answered364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Not Answered364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2287010Medicaid