Provider Demographics
NPI:1275803447
Name:KOTITSCHKE, KAREN (NP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:KOTITSCHKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 S. BUENA VISTA STREET,
Mailing Address - Street 2:SUITE #215 LAKESIDE COMMUNITY HEALTHCARE
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4505
Mailing Address - Country:US
Mailing Address - Phone:818-295-6944
Mailing Address - Fax:
Practice Address - Street 1:191 S. BUENA VISTA STREET,
Practice Address - Street 2:SUITE #215 LAKESIDE COMMUNITY HEALTHCARE
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4505
Practice Address - Country:US
Practice Address - Phone:818-295-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21210363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health