Provider Demographics
NPI:1619319092
Name:HENNEN, KAREN ANN (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:HENNEN
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 1:18 RIVERSIDE AVE S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 RIVERSIDE AVE S
Practice Address - Street 2:SUITE 220
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-1278
Practice Address - Country:US
Practice Address - Phone:320-255-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR184697-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse