Healthcare Provider Details

I. General information

NPI: 1790902682
Provider Name (Legal Business Name): KAREN R STUECKLEN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN R KALISH R.N.

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN STREET
STOCKBRIDGE MA
01262
US

IV. Provider business mailing address

1331 MANN HILL RD
POWNAL VT
05261-9496
US

V. Phone/Fax

Practice location:
  • Phone: 413-931-5320
  • Fax:
Mailing address:
  • Phone: 802-823-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number218132
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: