Basic Information
Provider Information | |||||||||
NPI: | 1720189962 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GARRETT | ||||||||
FirstName: | CAROLE | ||||||||
MiddleName: | PARONE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FEINMAN | ||||||||
OtherFirstName: | CAROLE | ||||||||
OtherMiddleName: | PARONE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CNM | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 15620 HEALDSBURG AVE | ||||||||
Address2: |   | ||||||||
City: | HEALDSBURG | ||||||||
State: | CA | ||||||||
PostalCode: | 954489617 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7074734531 | ||||||||
FaxNumber: | 7074734559 | ||||||||
Practice Location | |||||||||
Address1: | 3317 CHANATE RD | ||||||||
Address2: | SUITE 2C | ||||||||
City: | SANTA ROSA | ||||||||
State: | CA | ||||||||
PostalCode: | 954041737 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7075701130 | ||||||||
FaxNumber: | 7075712478 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/26/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 271 | CA | Y |   | Other Service Providers | Midwife |   |
No ID Information.