Provider Demographics
NPI:1518075225
Name:DICANZIO, KAREN S (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:DICANZIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD STE 5
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3736
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:084-731-2105
Practice Address - Street 1:440 E CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1374
Practice Address - Country:US
Practice Address - Phone:508-298-1300
Practice Address - Fax:508-298-1301
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA166995363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1205OtherMABC
MANP1205Medicare ID - Type Unspecified