Provider Demographics
NPI:1497008056
Name:WHITEMANRUNSHIM, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WHITEMANRUNSHIM
Suffix:
Gender:F
Credentials:
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 186
Mailing Address - Street 2:
Mailing Address - City:LODGE GRASS
Mailing Address - State:MT
Mailing Address - Zip Code:59050-0186
Mailing Address - Country:US
Mailing Address - Phone:406-639-2317
Mailing Address - Fax:406-639-2976
Practice Address - Street 1:101 JOHN NOMEE CIRCLE
Practice Address - Street 2:
Practice Address - City:LODGE GRASS
Practice Address - State:MT
Practice Address - Zip Code:59050-0186
Practice Address - Country:US
Practice Address - Phone:406-639-2317
Practice Address - Fax:406-639-2976
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17958163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse