Provider Demographics
NPI:1497308027
Name:POWELL, KAREN CAROL
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:CAROL
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75734 WEST RD
Mailing Address - Street 2:
Mailing Address - City:BUTTERNUT
Mailing Address - State:WI
Mailing Address - Zip Code:54514-9149
Mailing Address - Country:US
Mailing Address - Phone:715-661-3650
Mailing Address - Fax:
Practice Address - Street 1:75734 WEST RD
Practice Address - Street 2:
Practice Address - City:BUTTERNUT
Practice Address - State:WI
Practice Address - Zip Code:54514-9149
Practice Address - Country:US
Practice Address - Phone:715-661-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00000000000000000000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health