Healthcare Provider Details

I. General information

NPI: 1841458825
Provider Name (Legal Business Name): KAREN L MCKENNA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 JACKSON ST
MOSINEE WI
54455-1347
US

IV. Provider business mailing address

802 JACKSON ST
MOSINEE WI
54455-1347
US

V. Phone/Fax

Practice location:
  • Phone: 715-692-4040
  • Fax:
Mailing address:
  • Phone: 715-692-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number128409-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: