Provider Demographics
NPI:1225097405
Name:NELSON, KAREN H (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:H
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NW BARSTOW ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3771
Mailing Address - Country:US
Mailing Address - Phone:262-548-6903
Mailing Address - Fax:262-548-3820
Practice Address - Street 1:210 NW BARSTOW ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3771
Practice Address - Country:US
Practice Address - Phone:262-548-6903
Practice Address - Fax:262-548-3820
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015291207Q00000X
WI52000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME022425OtherANTHEM
ME102320000Medicaid
2183007OtherFIRST HEALTH
4657228OtherAETNA US HEALTHCARE
WI1225097405Medicaid
WI1225097405Medicaid
ME022425OtherANTHEM
WI68-086 0391Medicare PIN
WI1225097405Medicaid