Provider Demographics
NPI:1346642089
Name:MICHELSON, KAREN (AGPCNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:MICHELSON
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19015 VAN AKEN BLVD
Mailing Address - Street 2:APT. 412
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3575
Mailing Address - Country:US
Mailing Address - Phone:216-544-5561
Mailing Address - Fax:
Practice Address - Street 1:5829 DARROW RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3801
Practice Address - Country:US
Practice Address - Phone:234-205-0243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16492-NP363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology