Provider Demographics
NPI:1548451685
Name:KELLEHER, KAREN RUTH (LVN)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RUTH
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:LVN
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 564
Mailing Address - Street 2:4620 LUCKY LANE
Mailing Address - City:LOTUS
Mailing Address - State:CA
Mailing Address - Zip Code:95651-0564
Mailing Address - Country:US
Mailing Address - Phone:530-626-1255
Mailing Address - Fax:
Practice Address - Street 1:4620 LUCKY LANE
Practice Address - Street 2:
Practice Address - City:LOTUS
Practice Address - State:CA
Practice Address - Zip Code:95651-0564
Practice Address - Country:US
Practice Address - Phone:530-626-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN121814164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse