Healthcare Provider Details

I. General information

NPI: 1275981482
Provider Name (Legal Business Name): KAREN A GODERSTAD REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN A OSWALD LPN ,RN

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N4514 LINDA ST
CAMBRIDGE WI
53523-9508
US

IV. Provider business mailing address

N4514 LINDA ST
CAMBRIDGE WI
53523-9508
US

V. Phone/Fax

Practice location:
  • Phone: 608-449-8860
  • Fax:
Mailing address:
  • Phone: 608-449-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number97810-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: