Provider Demographics
NPI:1326337403
Name:DISTELHORST, KAREN (GCNS-BC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DISTELHORST
Suffix:
Gender:F
Credentials:GCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 DUNSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5918
Mailing Address - Country:US
Mailing Address - Phone:330-645-0641
Mailing Address - Fax:
Practice Address - Street 1:650 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1052
Practice Address - Country:US
Practice Address - Phone:330-590-0847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN21200763 COA02806364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology