Provider Demographics
NPI:1306174024
Name:KARLEEN, MEGAN ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:KARLEEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:LARSON AND BAUMBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:509 HAMMILL LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1004
Mailing Address - Country:US
Mailing Address - Phone:775-332-0300
Mailing Address - Fax:775-332-0311
Practice Address - Street 1:509 HAMMILL LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1004
Practice Address - Country:US
Practice Address - Phone:775-332-0300
Practice Address - Fax:775-332-0311
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1865363A00000X
IL085003630363A00000X
CA56802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant