Healthcare Provider Details

I. General information

NPI: 1437718350
Provider Name (Legal Business Name): CAROLYN ELAYNE PROTTER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN ELAYNE KIRWAN

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S TUSTIN ST
ORANGE CA
92866-3425
US

IV. Provider business mailing address

11111 ARDATH AVE
INGLEWOOD CA
90303-2416
US

V. Phone/Fax

Practice location:
  • Phone: 714-922-4100
  • Fax:
Mailing address:
  • Phone: 818-913-6824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95228540
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number236139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: