Provider Demographics
NPI:1184730723
Name:TIEDEKEN, KAREN (CRNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TIEDEKEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 HAMILTON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6122
Practice Address - Country:US
Practice Address - Phone:484-664-7555
Practice Address - Fax:484-664-7530
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP003541363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology