Provider Demographics
NPI:1043698475
Name:WEZNER, KAREN ANN (PMHNP-BC, MED, RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:WEZNER
Suffix:
Gender:F
Credentials:PMHNP-BC, MED, RN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:NYCEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BSN, RN
Mailing Address - Street 1:44432 BROADMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8630
Mailing Address - Country:US
Mailing Address - Phone:734-786-4964
Mailing Address - Fax:734-786-2316
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704127034363LP0808X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI363LP0808XOtherNPI