1457873465 NPI number — MRS. CAROL FAYE KANE REGISTERED DIETITIAN

Table of content: MRS. CAROL FAYE KANE REGISTERED DIETITIAN (NPI 1457873465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457873465 NPI number — MRS. CAROL FAYE KANE REGISTERED DIETITIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANE
Provider First Name:
CAROL
Provider Middle Name:
FAYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED DIETITIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH, STRONG
Provider Other First Name:
CAROL
Provider Other Middle Name:
FAYE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDN CNSC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457873465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2936 ROBINSON CREEK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95758-3620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-203-3441
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2936 ROBINSON CREEK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95758-3620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-203-3441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1006X , with the licence number:  328292 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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