Provider Demographics
NPI:1386775344
Name:HADDOCK, CAROL J (RN-BC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:J
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28644
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-0644
Mailing Address - Country:US
Mailing Address - Phone:858-676-0088
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX434639163WA2000X, 163WC1500X, 163WD0400X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care