Provider Demographics
NPI:1912920968
Name:BJORN, KAREN (PA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:BJORN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7779
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011
Mailing Address - Country:US
Mailing Address - Phone:602-252-2133
Mailing Address - Fax:602-258-0123
Practice Address - Street 1:6424 E BROADWAY RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1750
Practice Address - Country:US
Practice Address - Phone:480-684-6487
Practice Address - Fax:480-386-6646
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ321082Medicaid
65927Medicare ID - Type Unspecified
R99083Medicare UPIN