Healthcare Provider Details

I. General information

NPI: 1629212543
Provider Name (Legal Business Name): CAROLYN B JARVILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR
SITKA AK
99835-9416
US

IV. Provider business mailing address

65-1692 KOHALA MTN RD
KAMUELA HI
96743-8476
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-8442
  • Fax:
Mailing address:
  • Phone: 808-640-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN 24760
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberNUR R12083
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: