Provider Demographics
NPI:1437718350
Name:PROTTER, CAROLYN ELAYNE (CNM)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ELAYNE
Last Name:PROTTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ELAYNE
Other - Last Name:KIRWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11111 ARDATH AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2416
Mailing Address - Country:US
Mailing Address - Phone:818-913-6824
Mailing Address - Fax:
Practice Address - Street 1:700 S TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3425
Practice Address - Country:US
Practice Address - Phone:714-922-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95228540163W00000X
CA236139176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse