Provider Demographics
NPI:1679562649
Name:NUGENT, KAREN (PT, CHT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:NUGENT
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TAMAL VISTA BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1114
Mailing Address - Country:US
Mailing Address - Phone:415-927-2007
Mailing Address - Fax:415-927-7272
Practice Address - Street 1:21 TAMAL VISTA BLVD STE 113
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1114
Practice Address - Country:US
Practice Address - Phone:415-927-2007
Practice Address - Fax:415-927-7272
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12387174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABZ618ZMedicare PIN