Provider Demographics
NPI:1093312365
Name:RADER, KARENANN EDITH (BGS)
Entity Type:Individual
Prefix:MRS
First Name:KARENANN
Middle Name:EDITH
Last Name:RADER
Suffix:
Gender:F
Credentials:BGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-9497
Mailing Address - Country:US
Mailing Address - Phone:330-612-3605
Mailing Address - Fax:330-364-3033
Practice Address - Street 1:384 ASPEN DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9497
Practice Address - Country:US
Practice Address - Phone:330-612-3605
Practice Address - Fax:330-364-3033
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
OH7910396376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver