Healthcare Provider Details

I. General information

NPI: 1790984854
Provider Name (Legal Business Name): KAREN C CARROLL R.N., C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

1744 CATALPA RD
CARLSBAD CA
92011-5106
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax:
Mailing address:
  • Phone: 760-519-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number334318
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number1417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: