Provider Demographics
NPI:1679165567
Name:DELRIE, CAROLYN (RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:DELRIE
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:BAYNE JONES
Mailing Address - Street 2:1585 THIRD STREET
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71496
Mailing Address - Country:US
Mailing Address - Phone:337-378-5961
Mailing Address - Fax:
Practice Address - Street 1:BAYNE JONES
Practice Address - Street 2:1585 THIRD STREET
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71496
Practice Address - Country:US
Practice Address - Phone:337-378-5961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN074919163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management