Provider Demographics
NPI:1265575096
Name:DICK, KAREN LEE (PHD, NP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LEE
Last Name:DICK
Suffix:
Gender:F
Credentials:PHD, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 OLD WESTBORO RD.
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1903
Mailing Address - Country:US
Mailing Address - Phone:508-839-2461
Mailing Address - Fax:
Practice Address - Street 1:1 DEL POND DRIVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02120
Practice Address - Country:US
Practice Address - Phone:781-821-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA131733363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology