Provider Demographics
NPI:1144277781
Name:TRAVIS, CAROL E (CNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:E
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18200 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5605
Mailing Address - Country:US
Mailing Address - Phone:216-476-7606
Mailing Address - Fax:216-476-6967
Practice Address - Street 1:18200 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5605
Practice Address - Country:US
Practice Address - Phone:216-476-7606
Practice Address - Fax:216-476-6967
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN079550163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH353419OtherWELLCARE
OH000000311622OtherANTHEM BC /BS
OH500030376OtherRAILROAD CARE
OH2373499Medicaid
OH353419OtherWELLCARE
OH2373499Medicaid