Provider Demographics
NPI:1770033375
Name:WADDINGHAM, KAREN J (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:WADDINGHAM
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 1:39 GREENBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:COEYMANS HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:12046-2119
Mailing Address - Country:US
Mailing Address - Phone:518-756-2734
Mailing Address - Fax:
Practice Address - Street 1:15 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143-1235
Practice Address - Country:US
Practice Address - Phone:518-756-4512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 682651163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse