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NPI Code Detail

MEDICARE: KAREN MARIE LARCOM RN

MEDICARE: KAREN MARIE LARCOM 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
1163W00000XRegistered Nurse134898KS

General Provider Information

NPI Number : 1790278539
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN MARIE LARCOM RN
Provider Business Mailing Address
First Line : 9415 E HARRY ST STE 706
Second Line :
City : WICHITA
State : KS
Zip : 67207-5084
Country : US
Telephone Number : 316-652-2590
Fax Number : 316-652-2595
Provider Business Practice Location Address
First Line : 9415 E HARRY ST STE 706
Second Line :
City : WICHITA
State : KS
Zip : 67207-5084
Country : US
Telephone Number : 316-652-2590
Fax Number : 316-652-2595
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2018
Last Update Date : 06/06/2018

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