Provider Demographics
NPI:1124641758
Name:PAULOSKY-BENTON, KAREN ANNE (RN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNE
Last Name:PAULOSKY-BENTON
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 1:9702 BLUFF TRL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-9507
Mailing Address - Country:US
Mailing Address - Phone:231-590-9758
Mailing Address - Fax:
Practice Address - Street 1:626 E EIGHTH ST STE 17
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2504
Practice Address - Country:US
Practice Address - Phone:231-590-9758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704139056163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse