Provider Demographics
NPI:1497934707
Name:IVERSEN, CAROLYN EILEEN (RN)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:EILEEN
Last Name:IVERSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:BIGGS
Mailing Address - State:CA
Mailing Address - Zip Code:95917
Mailing Address - Country:US
Mailing Address - Phone:530-868-0779
Mailing Address - Fax:530-868-0779
Practice Address - Street 1:2952 FIRST STREET
Practice Address - Street 2:
Practice Address - City:BIGGS
Practice Address - State:CA
Practice Address - Zip Code:95917
Practice Address - Country:US
Practice Address - Phone:530-868-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507070163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN005040OtherMEDI CAL