Provider Demographics
NPI:1003046327
Name:REGION, CARMEN L (LPN)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:L
Last Name:REGION
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CARMEN
Other - Middle Name:L
Other - Last Name:HANABURGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:23 FIDDLERS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STAATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12580-5727
Mailing Address - Country:US
Mailing Address - Phone:845-889-8223
Mailing Address - Fax:
Practice Address - Street 1:23 FIDDLERS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:STAATSBURG
Practice Address - State:NY
Practice Address - Zip Code:12580-5727
Practice Address - Country:US
Practice Address - Phone:845-889-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 217985164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse