Healthcare Provider Details

I. General information

NPI: 1548357494
Provider Name (Legal Business Name): KAREN IRENE BLOCK CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11649 N PORT WASHINGTON RD #109
MEQUON WI
53092
US

IV. Provider business mailing address

W51 N214 FILLMORE CIRCLE
CEDARBURG WI
53012
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-8022
  • Fax: 267-241-8047
Mailing address:
  • Phone: 262-375-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279S1500X
TaxonomySNF/Subacute Care Registered Respiratory Therapist
License Number1539 028
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: