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NPI Code Detail

MEDICARE: CAROLYN GROGAN LPN

MEDICARE: CAROLYN GROGAN LPN
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
1164W00000XLicensed Practical NurseLPN07950NV

General Provider Information

NPI Number : 1801227137
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN GROGAN LPN
Provider Business Mailing Address
First Line : PO BOX 3902
Second Line :
City : LAS VEGAS
State : NV
Zip : 89127-3902
Country : US
Telephone Number : 702-759-1510
Fax Number : 702-759-1464
Provider Business Practice Location Address
First Line : 330 S VALLEY VIEW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-4361
Country : US
Telephone Number : 702-759-1510
Fax Number : 702-759-1464
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2013
Last Update Date : 12/12/2013

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Directions to “ CAROLYN GROGAN LPN” Practice Location

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