Provider Demographics
NPI:1205322872
Name:SHADRICK, KAREN ANNE
Entity type:Individual
Prefix:
First Name:KAREN ANNE
Middle Name:
Last Name:SHADRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN ANNE
Other - Middle Name:
Other - Last Name:LORENZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2835 OSTROM AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1606
Mailing Address - Country:US
Mailing Address - Phone:714-747-6528
Mailing Address - Fax:
Practice Address - Street 1:150 PAULARINO AVE STE D182
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3302
Practice Address - Country:US
Practice Address - Phone:888-336-3649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-07
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA700810163W00000X
CA95013316363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse