Healthcare Provider Details

I. General information

NPI: 1063841930
Provider Name (Legal Business Name): CAROLYN MARKHAM R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HILLMONT AVE
VENTURA CA
93003-1647
US

IV. Provider business mailing address

200 HILLMONT STREET
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-5755
  • Fax: 805-652-5765
Mailing address:
  • Phone: 805-652-6729
  • Fax: 805-652-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number671135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: