Healthcare Provider Details

I. General information

NPI: 1457407298
Provider Name (Legal Business Name): CAROLINA E SANCHEZ-VAN KOMEN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 AGENCY LOOP RD BOX 357
WELLPINIT WA
99040
US

IV. Provider business mailing address

PO BOX 193 5273 HUBERT RD
FORD WA
99013-0193
US

V. Phone/Fax

Practice location:
  • Phone: 509-258-4517
  • Fax:
Mailing address:
  • Phone: 509-258-9011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00024084
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: