Provider Demographics
NPI:1336510676
Name:FANNING, CAITLIN (ND)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:
Last Name:FANNING
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 ERIN LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-2006
Mailing Address - Country:US
Mailing Address - Phone:831-854-7471
Mailing Address - Fax:
Practice Address - Street 1:515 BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4621
Practice Address - Country:US
Practice Address - Phone:831-854-7471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND978175F00000X
WANT60606775175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath