Provider Demographics
NPI:1457407298
Name:SANCHEZ-VAN KOMEN, CAROLINA E (LPN)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:E
Last Name:SANCHEZ-VAN KOMEN
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 193
Mailing Address - Street 2:5273 HUBERT RD
Mailing Address - City:FORD
Mailing Address - State:WA
Mailing Address - Zip Code:99013-0193
Mailing Address - Country:US
Mailing Address - Phone:509-258-9011
Mailing Address - Fax:
Practice Address - Street 1:6203 AGENCY LOOP RD
Practice Address - Street 2:BOX 357
Practice Address - City:WELLPINIT
Practice Address - State:WA
Practice Address - Zip Code:99040
Practice Address - Country:US
Practice Address - Phone:509-258-4517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00024084164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse