Healthcare Provider Details

I. General information

NPI: 1497308027
Provider Name (Legal Business Name): KAREN CAROL POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75734 WEST RD
BUTTERNUT WI
54514-9149
US

IV. Provider business mailing address

75734 WEST RD
BUTTERNUT WI
54514-9149
US

V. Phone/Fax

Practice location:
  • Phone: 715-661-3650
  • Fax:
Mailing address:
  • Phone: 715-661-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number00000000000000000000
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: