Healthcare Provider Details

I. General information

NPI: 1790336907
Provider Name (Legal Business Name): LAURA ANNE KARADIMAS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2019
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 S CARNEY DR
SAINT CLAIR MI
48079-5569
US

IV. Provider business mailing address

1163 S CARNEY DR
SAINT CLAIR MI
48079-5569
US

V. Phone/Fax

Practice location:
  • Phone: 810-561-8450
  • Fax: 810-329-0156
Mailing address:
  • Phone: 810-561-8450
  • Fax: 810-329-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704190382
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: