Provider Demographics
NPI:1811024599
Name:CHASE, CAROLYN RUTH (RN, NP)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:RUTH
Last Name:CHASE
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Gender:F
Credentials:RN, NP
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Mailing Address - Street 1:1179 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6559
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:707-559-7707
Practice Address - Street 1:3 SIXTH ST.
Practice Address - Street 2:
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:707-559-7500
Practice Address - Fax:707-559-7707
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2024-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA515250163W00000X
CA9465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse