Basic Information
| Provider Information | |||||||||
| NPI: | 1760785851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MRNAK | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 4TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563341820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206344521 | ||||||||
| FaxNumber: | 3206342244 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 4TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563341820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206344521 | ||||||||
| FaxNumber: | 3206342244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2010 | ||||||||
| LastUpdateDate: | 12/10/2010 | ||||||||
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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 | 163WC2100X | 2005454158 | MN | N | Nursing Service Providers | Registered Nurse | Continence Care | 163WW0000X | 2005454158 | MN | Y | Nursing Service Providers | Registered Nurse | Wound Care | 163WX1500X | 2005454158 | MN | N | Nursing Service Providers | Registered Nurse | Ostomy Care |
No ID Information.