Provider Demographics
NPI:1376589713
Name:ANDERSON, KAREN G (APRN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:G
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:56A WARREN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-2205
Mailing Address - Country:US
Mailing Address - Phone:508-366-2271
Mailing Address - Fax:508-366-5948
Practice Address - Street 1:45 LYMAN ST
Practice Address - Street 2:SUITE 19
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2628
Practice Address - Country:US
Practice Address - Phone:508-366-2271
Practice Address - Fax:508-366-5948
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177047364SP0809X, 364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAR91664Medicare UPIN
MAGA NS0065Medicare ID - Type Unspecified