Provider Demographics
NPI:1649582354
Name:RAEDER, KAREN LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:RAEDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SOUTH RD.
Mailing Address - Street 2:MACORMICK SECURE CENTER
Mailing Address - City:BROOKTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14817
Mailing Address - Country:US
Mailing Address - Phone:607-539-7121
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTH RD
Practice Address - Street 2:
Practice Address - City:BROOKTONDALE
Practice Address - State:NY
Practice Address - Zip Code:14817-9722
Practice Address - Country:US
Practice Address - Phone:607-539-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33 336388363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner