Provider Demographics
NPI:1376799742
Name:CLINTON, KAREN (RN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:CLINTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:9114 MAIN ST
Mailing Address - City:STITTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13469-0171
Mailing Address - Country:US
Mailing Address - Phone:315-865-8425
Mailing Address - Fax:
Practice Address - Street 1:9114 MAIN ST
Practice Address - Street 2:
Practice Address - City:STITTVILLE
Practice Address - State:NY
Practice Address - Zip Code:13469
Practice Address - Country:US
Practice Address - Phone:315-865-8425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226278-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02882891Medicaid