Provider Demographics
NPI:1710088802
Name:DZIUBA, KAREN MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MARIE
Last Name:DZIUBA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1117S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2558
Mailing Address - Country:US
Mailing Address - Phone:989-791-4020
Mailing Address - Fax:989-921-8765
Practice Address - Street 1:630 PROGRESS ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-8603
Practice Address - Country:US
Practice Address - Phone:989-345-5020
Practice Address - Fax:989-343-1899
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704149174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI50-0-87-6693-0Medicare UPIN
MI4325710Medicare ID - Type Unspecified