Healthcare Provider Details

I. General information

NPI: 1255517819
Provider Name (Legal Business Name): CAROLYN LARROWE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MULLINS DR SUIT1 A-1
LEBANON OR
97355-3982
US

IV. Provider business mailing address

PO BOX 579
CORVALLIS OR
97339-0579
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-6920
  • Fax: 541-451-6924
Mailing address:
  • Phone: 541-766-6835
  • Fax: 541-766-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number079044097RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: