Healthcare Provider Details

I. General information

NPI: 1275803447
Provider Name (Legal Business Name): KAREN KOTITSCHKE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S. BUENA VISTA STREET, SUITE #215 LAKESIDE COMMUNITY HEALTHCARE
BURBANK CA
91505-4505
US

IV. Provider business mailing address

191 S. BUENA VISTA STREET, SUITE #215 LAKESIDE COMMUNITY HEALTHCARE
BURBANK CA
91505-4505
US

V. Phone/Fax

Practice location:
  • Phone: 818-295-6944
  • Fax:
Mailing address:
  • Phone: 818-295-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number21210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: