Provider Demographics
NPI:1548032592
Name:VANVELSE, CARRIE BREANNE (LSW, HFA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:BREANNE
Last Name:VANVELSE
Suffix:
Gender:F
Credentials:LSW, HFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 BOBTAIL DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-5536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10531 E 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2604
Practice Address - Country:US
Practice Address - Phone:317-683-8114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14005255A376G00000X
INCNA1305348376K00000X
IN3301148A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No376G00000XNursing Service Related ProvidersNursing Home Administrator
No376K00000XNursing Service Related ProvidersNurse's Aide