Healthcare Provider Details

I. General information

NPI: 1801163316
Provider Name (Legal Business Name): KAREN VAN ECK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 E MICHIGAN AVE
JACKSON MI
49202-3971
US

IV. Provider business mailing address

PO BOX 67000 DEPARTMENT 272801
DETROIT MI
48267-2728
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-3280
  • Fax: 517-787-9680
Mailing address:
  • Phone: 517-841-7490
  • Fax: 517-841-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704249001
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: