Provider Demographics
NPI:1295317022
Name:FORD, KAREN RENEE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:RENEE
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LAKE OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2931
Mailing Address - Country:US
Mailing Address - Phone:301-455-7599
Mailing Address - Fax:
Practice Address - Street 1:900 LAKE OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2931
Practice Address - Country:US
Practice Address - Phone:301-455-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant