Healthcare Provider Details

I. General information

NPI: 1457651762
Provider Name (Legal Business Name): CAROLINE JEAN HART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CROWN POINT CIRCLE SUITE 200
GRASS VALLEY CA
95945-9514
US

IV. Provider business mailing address

500 CROWN POINT CIR STE 200
GRASS VALLEY CA
95945-9561
US

V. Phone/Fax

Practice location:
  • Phone: 530-470-2425
  • Fax:
Mailing address:
  • Phone: 530-470-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number256797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: