Provider Demographics
NPI:1588683288
Name:ABRAHAMSON, KARYN (NP)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:ABRAHAMSON
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:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0428
Mailing Address - Country:US
Mailing Address - Phone:231-775-6076
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:110 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1233
Practice Address - Country:US
Practice Address - Phone:231-723-9190
Practice Address - Fax:231-723-9191
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704163017363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4896890-11Medicaid
MI4896890-11Medicaid
N87230-003Medicare PIN