Provider Demographics
NPI:1871846311
Name:MCNULTY, KAREN SUZANNE (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUZANNE
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 SE 186TH PL
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-7410
Mailing Address - Country:US
Mailing Address - Phone:503-449-9946
Mailing Address - Fax:
Practice Address - Street 1:10373 NE HANCOCK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3873
Practice Address - Country:US
Practice Address - Phone:503-253-6754
Practice Address - Fax:503-253-8020
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60583471363LP0808X
OR201250161NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health