Provider Demographics
NPI:1629733795
Name:MCKEAN, CARLA JUNE (RN 00080056)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JUNE
Last Name:MCKEAN
Suffix:
Gender:F
Credentials:RN 00080056
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7656 STONECREST RD NE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-8957
Mailing Address - Country:US
Mailing Address - Phone:509-750-4946
Mailing Address - Fax:509-764-6019
Practice Address - Street 1:7656 STONECREST RD NE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-8957
Practice Address - Country:US
Practice Address - Phone:509-750-4946
Practice Address - Fax:509-764-6019
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00080056163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse