Healthcare Provider Details

I. General information

NPI: 1396493243
Provider Name (Legal Business Name): KAREN LAST NURSE PRACTITIONER P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WAMPANOAG TRL
RIVERSIDE RI
02915-1504
US

IV. Provider business mailing address

PO BOX 25
RAYNHAM CENTER MA
02768-0025
US

V. Phone/Fax

Practice location:
  • Phone: 401-431-9870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN03028
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2295628
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: