Provider Demographics
NPI:1053442665
Name:MANSON, KAREN RENEE (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RENEE
Last Name:MANSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W ARROW HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2337
Mailing Address - Country:US
Mailing Address - Phone:909-592-9246
Mailing Address - Fax:909-592-9248
Practice Address - Street 1:1305 W ARROW HWY STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2337
Practice Address - Country:US
Practice Address - Phone:909-592-9246
Practice Address - Fax:909-592-9248
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN357409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily