Healthcare Provider Details

I. General information

NPI: 1306412622
Provider Name (Legal Business Name): CAROLINE PARIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15301 WARREN SHINGLE RD
BEALE AFB CA
95903-1905
US

IV. Provider business mailing address

7202 TRAPPERS PL
SPRINGFIELD VA
22153-1332
US

V. Phone/Fax

Practice location:
  • Phone: 530-634-2941
  • Fax:
Mailing address:
  • Phone: 703-505-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: