Provider Demographics
NPI:1114779923
Name:WAHL, KAREN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WAHL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:PENSYL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:2956 AIRWAY RD
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-9329
Mailing Address - Country:US
Mailing Address - Phone:585-593-6738
Mailing Address - Fax:585-593-6768
Practice Address - Street 1:2956 AIRWAY RD
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-9329
Practice Address - Country:US
Practice Address - Phone:585-593-6738
Practice Address - Fax:585-593-6768
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY456477-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse