Provider Demographics
NPI:1033960513
Name:WILSON, KAREN SUE (MSN, RN, ACCNS-P)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSN, RN, ACCNS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5572 SENEY CIR N
Mailing Address - Street 2:
Mailing Address - City:HAMBURG TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48189-8165
Mailing Address - Country:US
Mailing Address - Phone:740-506-1244
Mailing Address - Fax:
Practice Address - Street 1:1540 E MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-0100
Practice Address - Country:US
Practice Address - Phone:734-615-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284719364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics