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NPI Code Detail

MEDICARE: KAREN ELENA BLACK RN

MEDICARE: KAREN ELENA BLACK RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC1500XCommunity Health Registered Nurse4704229788MI

General Provider Information

NPI Number : 1861602286
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN ELENA BLACK RN
Provider Business Mailing Address
First Line : 18674 RUTHERFORD ST
Second Line :
City : DETROIT
State : MI
Zip : 48235-2942
Country : US
Telephone Number : 313-870-0013
Fax Number :
Provider Business Practice Location Address
First Line : 6309 MACK AVE
Second Line :
City : DETROIT
State : MI
Zip : 48207-2302
Country : US
Telephone Number : 313-424-0390
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 04/02/2025

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