Basic Information
| Provider Information | |||||||||
| NPI: | 1710979190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIM | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | GNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 DANTLEY WAY | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945981804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259450497 | ||||||||
| FaxNumber: | 4152928845 | ||||||||
| Practice Location | |||||||||
| Address1: | 1333 BUSH ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941095611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152928888 | ||||||||
| FaxNumber: | 4152928845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 01/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 469377 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.