Provider Demographics
NPI:1801039359
Name:DIMASO, KAREN (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DIMASO
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 1:3123 SHORE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4287
Mailing Address - Country:US
Mailing Address - Phone:715-732-2299
Mailing Address - Fax:715-732-2419
Practice Address - Street 1:3123 SHORE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4287
Practice Address - Country:US
Practice Address - Phone:715-732-2299
Practice Address - Fax:715-732-2419
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114750-030163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391999260OtherEIN