Provider Demographics
NPI:1801227137
Name:GROGAN, CAROLYN (LPN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:GROGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3902
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89127-3902
Mailing Address - Country:US
Mailing Address - Phone:702-759-1510
Mailing Address - Fax:702-759-1464
Practice Address - Street 1:330 S VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-4361
Practice Address - Country:US
Practice Address - Phone:702-759-1510
Practice Address - Fax:702-759-1464
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN07950164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse