Provider Demographics
NPI:1568408433
Name:PAWELEK, KAREN MICHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELLE
Last Name:PAWELEK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RETREAT AVE
Mailing Address - Street 2:RESEARCH BUILDING 8TH FLOOR
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3309
Mailing Address - Country:US
Mailing Address - Phone:860-545-7596
Mailing Address - Fax:860-545-7875
Practice Address - Street 1:200 RETREAT AVE
Practice Address - Street 2:RESEARCH BUILDING 8TH FLOOR
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3309
Practice Address - Country:US
Practice Address - Phone:860-545-7596
Practice Address - Fax:860-545-7875
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR030966363LA2200X
CT003608363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1568408433Medicaid
CT500001989Medicare PIN
CTP48888Medicare UPIN