Provider Demographics
NPI:1972557841
Name:GRAHAM-BURNET, KAREN E (PA)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:E
Last Name:GRAHAM-BURNET
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:E
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2174 DENTON ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5910
Mailing Address - Country:US
Mailing Address - Phone:937-766-8804
Mailing Address - Fax:
Practice Address - Street 1:2174 DENTON ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-5910
Practice Address - Country:US
Practice Address - Phone:608-406-5658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2559-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGRPA26002Medicare ID - Type Unspecified
P16272Medicare UPIN