MEDICARE: KARRY MIKEL CLOS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	NUR-LPN-LIC-98484	MT

General Provider Information

NPI Number	:	1356142574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARRY MIKEL CLOS LPN

Provider Business Mailing Address
First Line	:	2625 WINNE AVE # A1
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-4958
Country	:	US
Telephone Number	:	406-422-0114
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 WINNE AVE # A1
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-4958
Country	:	US
Telephone Number	:	406-422-0114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	03/24/2025

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