Basic Information
Provider Information
NPI: 1932396918
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KARLIN
FirstName: ERNEST
MiddleName: WERNER
NamePrefix:  
NameSuffix:  
Credential: B.S., RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 521 N MAIN ST
Address2:  
City: LA JUNTA
State: CO
PostalCode: 810509257
CountryCode: US
TelephoneNumber: 7193832052
FaxNumber:  
Practice Location
Address1: 711 BARNES AVE
Address2:  
City: LA JUNTA
State: CO
PostalCode: 810502138
CountryCode: US
TelephoneNumber: 7193845446
FaxNumber: 7193845672
Other Information
ProviderEnumerationDate: 10/03/2007
LastUpdateDate: 10/03/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 
163W00000X105936CON Nursing Service ProvidersRegistered Nurse 

No ID Information.


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