Provider Demographics
NPI:1609485424
Name:INTENSIVE KAREN LLC
Entity Type:Organization
Organization Name:INTENSIVE KAREN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOPAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, ACNP-BC
Authorized Official - Phone:847-636-1607
Mailing Address - Street 1:612 MULFORD ST APT 503
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3531
Mailing Address - Country:US
Mailing Address - Phone:847-636-1607
Mailing Address - Fax:
Practice Address - Street 1:612 MULFORD ST APT 503
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3531
Practice Address - Country:US
Practice Address - Phone:847-636-1607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty