Basic Information
| Provider Information | |||||||||
| NPI: | 1629337423 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARKINS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237947699 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | WARD C2 BLDG 200 | ||||||||
| Address2: | JAMES H. QUILLEN VAMC | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2012 | ||||||||
| LastUpdateDate: | 05/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | 158770 | TN | Y | Nursing Service Providers | Registered Nurse | Medical-Surgical |
No ID Information.