Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 6108 | NV |
NPI | 1063560506 |
---|---|
Provider Name | Dr. Karen Ann Raven |
First Address | Reno, NV 89509-6141 |
Second Address | Reno, NV 89509-6141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 20/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CC0886 | BLUECROSS BLUE SHIELD (01) | NV |
E62045 | (02) | NV |