Provider Demographics
NPI:1245388974
Name:ELDRIDGE, CAROLYN JEAN (LM)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JEAN
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 ALDERPOINT RD
Mailing Address - Street 2:
Mailing Address - City:GARBERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95542-9417
Mailing Address - Country:US
Mailing Address - Phone:707-223-1536
Mailing Address - Fax:707-923-3315
Practice Address - Street 1:3798 JANES RD STE 3
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4745
Practice Address - Country:US
Practice Address - Phone:707-826-2222
Practice Address - Fax:707-826-2223
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM0023176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife