Healthcare Provider Details

I. General information

NPI: 1679440002
Provider Name (Legal Business Name): KAREN ANN WIEKIERAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 OLYMPIC BLVD
EVERETT WA
98203-1918
US

IV. Provider business mailing address

220 OLYMPIC BLVD
EVERETT WA
98203-1918
US

V. Phone/Fax

Practice location:
  • Phone: 800-329-8387
  • Fax:
Mailing address:
  • Phone: 800-329-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704313662
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: