Provider Demographics
NPI:1366722530
Name:PEARSALL, CAROLYN THERESE (RN)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:THERESE
Last Name:PEARSALL
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 1:123 HAVILAND DRIVE
Mailing Address - Street 2:APT B
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563
Mailing Address - Country:US
Mailing Address - Phone:845-363-1034
Mailing Address - Fax:
Practice Address - Street 1:123 HAVILAND DRIVE
Practice Address - Street 2:APT B
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563
Practice Address - Country:US
Practice Address - Phone:845-363-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50107-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse