Healthcare Provider Details

I. General information

NPI: 1972832913
Provider Name (Legal Business Name): KAREN M WAUCHOPE RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

14 LAKE AVE
TUCKAHOE NY
10707-3921
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8306
  • Fax:
Mailing address:
  • Phone: 914-961-4487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number333524-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: