Provider Demographics
NPI:1710979190
Name:LIM, CAROL ANNE (GNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:LIM
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 DANTLEY WAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1804
Mailing Address - Country:US
Mailing Address - Phone:925-945-0497
Mailing Address - Fax:415-292-8845
Practice Address - Street 1:1333 BUSH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5611
Practice Address - Country:US
Practice Address - Phone:415-292-8888
Practice Address - Fax:415-292-8845
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469377363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology