Provider Demographics
NPI:1770133878
Name:TEAGUE, KAREN RENEE (RN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:RENEE
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:TEAGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1435 RIVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4509
Mailing Address - Country:US
Mailing Address - Phone:916-643-7154
Mailing Address - Fax:916-643-7154
Practice Address - Street 1:1435 RIVER PARK DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4509
Practice Address - Country:US
Practice Address - Phone:916-643-7154
Practice Address - Fax:916-643-7154
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410680163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management