Healthcare Provider Details

I. General information

NPI: 1073253233
Provider Name (Legal Business Name): KAREN LORENE WARDEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36322 COUNTY ROAD 390
GOBLES MI
49055-9072
US

IV. Provider business mailing address

36322 COUNTY ROAD 390
GOBLES MI
49055-9072
US

V. Phone/Fax

Practice location:
  • Phone: 269-492-8106
  • Fax:
Mailing address:
  • Phone: 269-492-8106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704213122
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: