Provider Demographics
NPI:1174054985
Name:CARROW, KAITLYN DAWN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:DAWN
Last Name:CARROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:DAWN
Other - Last Name:MORSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2407
Mailing Address - Country:US
Mailing Address - Phone:510-913-1326
Mailing Address - Fax:
Practice Address - Street 1:3200 ADELINE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2407
Practice Address - Country:US
Practice Address - Phone:510-913-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist