MEDICARE: MRS. CAROLINE SIMONE CHARPENTIER KERHERVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula		CA
2	174N00000X	Lactation Consultant (Non-RN)		CA

General Provider Information

NPI Number	:	1366785669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLINE SIMONE CHARPENTIER KERHERVE

Provider Business Mailing Address
First Line	:	580 BANKS ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-6112
Country	:	US
Telephone Number	:	415-867-6873
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 BANKS ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-6112
Country	:	US
Telephone Number	:	415-867-6873
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2013
Last Update Date	:	11/02/2013

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