Provider Demographics
NPI:1235337775
Name:CARROLL, CHRISTINE V (LVN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:V
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 WEST SACRAMENTO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3145
Mailing Address - Country:US
Mailing Address - Phone:530-514-0757
Mailing Address - Fax:
Practice Address - Street 1:1345 W SACRAMENTO AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-9655
Practice Address - Country:US
Practice Address - Phone:530-514-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN156026164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse