MEDICARE: LEE A CARN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	R24999	NM

General Provider Information

NPI Number	:	1144479361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE A CARN RN

Provider Business Mailing Address
First Line	:	800 FRUTA RD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-6557
Country	:	US
Telephone Number	:	505-892-6630
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 FRUTA RD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-6557
Country	:	US
Telephone Number	:	505-892-6630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	09/11/2008

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