Healthcare Provider Details

I. General information

NPI: 1720266224
Provider Name (Legal Business Name): KAREN FRAZIER LIPPARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD VA HOME BASED PRIMARY CARE
ANN ARBOR MI
48105-2303
US

IV. Provider business mailing address

2215 FULLER VA HOME BASED PRIMARY CARE
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-845-3664
  • Fax:
Mailing address:
  • Phone: 734-845-3664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704221005
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: