Healthcare Provider Details

I. General information

NPI: 1275696981
Provider Name (Legal Business Name): ELLEN MAY LARKIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GEISENBERGSTR B18
BRUCHMUHLBACH RHEINLAND PFALZ
66892
DE

IV. Provider business mailing address

LRMC CMR402 BOX1710
APO AE LANDSTIHL
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 63-725-0699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00018753
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: