Provider Demographics
NPI:1316646714
Name:EAGLE ARAGON, KAREN KAY (LPN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:KAY
Last Name:EAGLE ARAGON
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 8
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-0008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:282 CASA BLANCA RD
Practice Address - Street 2:
Practice Address - City:CASA BLANCA
Practice Address - State:NM
Practice Address - Zip Code:87007-1071
Practice Address - Country:US
Practice Address - Phone:505-285-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NML12096164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse