Provider Demographics
NPI:1922669092
Name:CARR, PAULINE (LM)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:CARR
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 1:755 SUNRISE AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4583
Mailing Address - Country:US
Mailing Address - Phone:916-786-6055
Mailing Address - Fax:
Practice Address - Street 1:6940 DESTINY DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2987
Practice Address - Country:US
Practice Address - Phone:916-223-7731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty