Provider Demographics
NPI:1235246323
Name:WALSER, KAREN (CNM)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WALSER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PARK PL
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4010
Mailing Address - Country:US
Mailing Address - Phone:401-729-0080
Mailing Address - Fax:401-729-0438
Practice Address - Street 1:42 PARK PL
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4010
Practice Address - Country:US
Practice Address - Phone:401-729-0080
Practice Address - Fax:401-729-0438
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMW00031367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKW55776Medicaid
RI007057108Medicare PIN
RIKW55776Medicaid