Provider Demographics
NPI:1053347963
Name:HART, CARLA ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:ANN
Last Name:HART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 S LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-5159
Mailing Address - Country:US
Mailing Address - Phone:330-821-4559
Mailing Address - Fax:330-823-6222
Practice Address - Street 1:2542 S LINDEN AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5159
Practice Address - Country:US
Practice Address - Phone:330-821-4559
Practice Address - Fax:330-823-6222
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.145775163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2436662Medicaid