Healthcare Provider Details

I. General information

NPI: 1336117399
Provider Name (Legal Business Name): KAREN A. STORLIE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 THOMPSON ST
BLOOMER WI
54724-1257
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-1510
US

V. Phone/Fax

Practice location:
  • Phone: 715-568-2000
  • Fax:
Mailing address:
  • Phone: 715-838-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR111790-5
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3716
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: