Healthcare Provider Details

I. General information

NPI: 1861602286
Provider Name (Legal Business Name): KAREN ELENA BLACK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 MACK AVE
DETROIT MI
48207-2302
US

IV. Provider business mailing address

18674 RUTHERFORD ST
DETROIT MI
48235-2942
US

V. Phone/Fax

Practice location:
  • Phone: 313-424-0390
  • Fax:
Mailing address:
  • Phone: 313-870-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704229788
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: