Provider Demographics
NPI:1790550341
Name:KANE, CAROLINE (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 EDITH ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3223
Mailing Address - Country:US
Mailing Address - Phone:415-205-5282
Mailing Address - Fax:
Practice Address - Street 1:241 EDITH ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3223
Practice Address - Country:US
Practice Address - Phone:415-205-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-3221624171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach