Healthcare Provider Details

I. General information

NPI: 1093848616
Provider Name (Legal Business Name): SHARON EILLEN KARN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 HIGHLAND DR
VANCOUVER WA
98661-7636
US

IV. Provider business mailing address

6505 HIGHLAND DR
VANCOUVER WA
98661-7636
US

V. Phone/Fax

Practice location:
  • Phone: 360-694-7332
  • Fax: 360-694-4024
Mailing address:
  • Phone: 360-694-7332
  • Fax: 360-694-4024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00001572
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP1 60033083
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8487
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: