Provider Demographics
NPI:1073669701
Name:RALLI, CAROL ANN (FNPC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:RALLI
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2017 SEBASTIAN WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3212
Mailing Address - Country:US
Mailing Address - Phone:916-791-8609
Mailing Address - Fax:
Practice Address - Street 1:1130 CONROY LN STE 402
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4153
Practice Address - Country:US
Practice Address - Phone:916-784-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP4912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS55732Medicare UPIN