Provider Demographics
NPI:1558515825
Name:CARLSEN, KAREN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:CARLSEN
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 1:28165 GRANDON STREET
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150
Mailing Address - Country:US
Mailing Address - Phone:734-674-3899
Mailing Address - Fax:248-588-2828
Practice Address - Street 1:1000 JOHN R RD
Practice Address - Street 2:STE 250
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4317
Practice Address - Country:US
Practice Address - Phone:248-588-9700
Practice Address - Fax:248-588-2828
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704172021163W00000X
IN28080663A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse