Healthcare Provider Details

I. General information

NPI: 1457873465
Provider Name (Legal Business Name): CAROL FAYE KANE REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROL FAYE SMITH, STRONG RDN CNSC

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2936 ROBINSON CREEK LN
ELK GROVE CA
95758-3620
US

IV. Provider business mailing address

2936 ROBINSON CREEK LN
ELK GROVE CA
95758-3620
US

V. Phone/Fax

Practice location:
  • Phone: 916-203-3441
  • Fax:
Mailing address:
  • Phone: 916-203-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number328292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: