Provider Demographics
NPI:1962731877
Name:SMITH, CAROL DEAN
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:DEAN
Last Name:SMITH
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 1:1436 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3718
Mailing Address - Country:US
Mailing Address - Phone:707-774-1062
Mailing Address - Fax:
Practice Address - Street 1:1436 SIERRA DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3718
Practice Address - Country:US
Practice Address - Phone:707-774-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide