Provider Demographics
NPI:1295473130
Name:BELKE, CAROLYNN RUTH
Entity type:Individual
Prefix:MS
First Name:CAROLYNN
Middle Name:RUTH
Last Name:BELKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 DE MOLL DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3220
Mailing Address - Country:US
Mailing Address - Phone:530-921-0018
Mailing Address - Fax:
Practice Address - Street 1:1236 DE MOLL DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3220
Practice Address - Country:US
Practice Address - Phone:530-921-0018
Practice Address - Fax:530-319-3799
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB8011905172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver