Provider Demographics
NPI:1639250665
Name:HEUSEL, KAREN JEANNINE DUBOIS (PHD, RN, NP)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:JEANNINE DUBOIS
Last Name:HEUSEL
Suffix:
Gender:F
Credentials:PHD, RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 BUENA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1026
Mailing Address - Country:US
Mailing Address - Phone:740-264-6504
Mailing Address - Fax:
Practice Address - Street 1:107 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8786
Practice Address - Country:US
Practice Address - Phone:740-695-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-08122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS84700Medicare UPIN
WVNP14021Medicare PIN