Provider Demographics
NPI:1417920075
Name:MCLANE, KAREN M (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:M
Last Name:MCLANE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:IHS SELLS SERVICE UNIT
Mailing Address - City:SELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85634-0548
Mailing Address - Country:US
Mailing Address - Phone:520-383-6800
Mailing Address - Fax:520-383-0700
Practice Address - Street 1:HIGHWAY 86 AND TOPAWA ROAD
Practice Address - Street 2:IHS SELLS SERVICE UNIT
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634-0548
Practice Address - Country:US
Practice Address - Phone:520-383-6800
Practice Address - Fax:520-383-0700
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily