Basic Information
| Provider Information | |||||||||
| NPI: | 1700947280 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOUGLAS | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | GRANSBERRY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3843 HARDING BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708075224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253599315 | ||||||||
| FaxNumber: | 2253599326 | ||||||||
| Practice Location | |||||||||
| Address1: | 3843 HARDING BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708075224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253599315 | ||||||||
| FaxNumber: | 2253599326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 063289 | LA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.