Healthcare Provider Details

I. General information

NPI: 1639314503
Provider Name (Legal Business Name): KAREN ROBERTS BURRITT RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN ROBERTS SWAB

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

IV. Provider business mailing address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

V. Phone/Fax

Practice location:
  • Phone: 616-242-0300
  • Fax:
Mailing address:
  • Phone: 616-242-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704145794
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: