Provider Demographics
NPI:1649455874
Name:GATHMAN, CAROLE LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:LYNN
Last Name:GATHMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:CAROLE
Other - Middle Name:LYNN
Other - Last Name:MILLIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679-4951
Mailing Address - Country:US
Mailing Address - Phone:949-292-6266
Mailing Address - Fax:
Practice Address - Street 1:11 LILAC LN
Practice Address - Street 2:SUITE 108
Practice Address - City:COTO DE CAZA
Practice Address - State:CA
Practice Address - Zip Code:92679-4951
Practice Address - Country:US
Practice Address - Phone:949-292-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041170329163WA0400X
CA799856163WA0400X
IL041-170329163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)