Provider Demographics
NPI:1780781575
Name:JOHANSEN, KAREN BARBARA (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:BARBARA
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LRMC
Mailing Address - Street 2:CMR 402 BOX 816
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:DE
Mailing Address - Phone:00149637-149-5578
Mailing Address - Fax:
Practice Address - Street 1:LRMC
Practice Address - Street 2:CMR 402 BOX 816
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:DE
Practice Address - Phone:00149637-149-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41221171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider