Healthcare Provider Details

I. General information

NPI: 1679722896
Provider Name (Legal Business Name): KAREN CAUDILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HICKORY RD STE 240
PLYMOUTH MEETING PA
19462-2225
US

IV. Provider business mailing address

PO BOX 10476
FORT WAYNE IN
46852-0476
US

V. Phone/Fax

Practice location:
  • Phone: 800-879-4471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28067938A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: