Provider Demographics
NPI:1083737746
Name:HUSSION, KAREN A (ANP-BC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:HUSSION
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:100 ROSEBROOK WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571
Practice Address - Country:US
Practice Address - Phone:508-273-4950
Practice Address - Fax:508-973-4951
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161769363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA00000000Medicaid
MA00000000Medicaid
MA000029201Medicare PIN