Provider Demographics
NPI:1558501510
Name:HUNT - WALDORF, KAREN JEANNE
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:JEANNE
Last Name:HUNT - WALDORF
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 1:1115 S VAN DYKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9615
Mailing Address - Country:US
Mailing Address - Phone:989-269-8886
Mailing Address - Fax:989-269-8886
Practice Address - Street 1:970 N VAN DYKE RD
Practice Address - Street 2:STE C
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-7910
Practice Address - Country:US
Practice Address - Phone:989-269-8886
Practice Address - Fax:989-269-8886
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist