Provider Demographics
NPI:1043476252
Name:LOFTUS, KAREN ANN (MSN ANP BC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:MSN ANP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18302 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-5007
Mailing Address - Country:US
Mailing Address - Phone:248-478-1500
Mailing Address - Fax:248-478-2798
Practice Address - Street 1:18302 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-5007
Practice Address - Country:US
Practice Address - Phone:248-478-1500
Practice Address - Fax:248-478-2798
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704145251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704145251OtherMICHIGAN LICENSE