Provider Demographics
NPI:1235845728
Name:CARNEY, LARESA JEAN
Entity Type:Individual
Prefix:
First Name:LARESA
Middle Name:JEAN
Last Name:CARNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-1443
Mailing Address - Country:US
Mailing Address - Phone:515-468-9154
Mailing Address - Fax:
Practice Address - Street 1:709 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-1443
Practice Address - Country:US
Practice Address - Phone:515-468-9154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA129478163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse