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General NPI Number Information
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NPI Number | 1073838900
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Entity Type | Individual
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Provider Name | CAROL ANNE HERRLIE RN, FNP
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Gender | Female
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Dates
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Enumeration Date | 04/03/2010
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Last Update Date | 04/03/2010
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Provider Practice Location Address
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Address Line | 5253 BUCKS BAR RD
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City | PLACERVILLE
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State | CA
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Zip | 95667-7869
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Country | US
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Telephone | 530-622-9124
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Fax | 530-626-0677
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Provider Business Mailing Address
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Address Line | 5253 BUCKS BAR RD
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City | PLACERVILLE
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State | CA
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Zip | 95667-7869
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Country | US
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Telephone | 530-622-9124
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Fax | 530-626-0677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | RN255133 FUNISNP3280
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License Number State | CA
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