Provider Demographics
NPI:1457873465
Name:KANE, CAROL FAYE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:FAYE
Last Name:KANE
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:FAYE
Other - Last Name:SMITH, STRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN CNSC
Mailing Address - Street 1:2936 ROBINSON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-3620
Mailing Address - Country:US
Mailing Address - Phone:916-203-3441
Mailing Address - Fax:
Practice Address - Street 1:2936 ROBINSON CREEK LN
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-3620
Practice Address - Country:US
Practice Address - Phone:916-203-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA328292133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty