Healthcare Provider Details

I. General information

NPI: 1073838900
Provider Name (Legal Business Name): CAROL ANNE HERRLIE RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2010
Last Update Date: 04/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5253 BUCKS BAR RD
PLACERVILLE CA
95667-7869
US

IV. Provider business mailing address

5253 BUCKS BAR RD
PLACERVILLE CA
95667-7869
US

V. Phone/Fax

Practice location:
  • Phone: 530-622-9124
  • Fax: 530-626-0677
Mailing address:
  • Phone: 530-622-9124
  • Fax: 530-626-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberRN255133 FUNISNP3280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: