Provider Demographics
NPI:1275981482
Name:GODERSTAD, KAREN A (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:GODERSTAD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:OSWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN ,RN
Mailing Address - Street 1:N4514 LINDA ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523-9508
Mailing Address - Country:US
Mailing Address - Phone:608-449-8860
Mailing Address - Fax:
Practice Address - Street 1:N4514 LINDA ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:WI
Practice Address - Zip Code:53523-9508
Practice Address - Country:US
Practice Address - Phone:608-449-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI97810-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health