Healthcare Provider Details

I. General information

NPI: 1609843770
Provider Name (Legal Business Name): KAREN SUE GRIFFIN PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN SUE PFUNDHENER PA C

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 ROBY RD
STOUGHTON WI
53589-1273
US

IV. Provider business mailing address

1632 ROBY RD
STOUGHTON WI
53589-1273
US

V. Phone/Fax

Practice location:
  • Phone: 608-877-2660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number277
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: