Provider Demographics
NPI:1932255650
Name:BOTTOM, KAREN (CNM)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BOTTOM
Suffix:
Gender:F
Credentials:CNM
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 660
Mailing Address - Street 2:85 SIERRA PARK RD
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-0660
Mailing Address - Country:US
Mailing Address - Phone:760-924-4044
Mailing Address - Fax:760-924-4125
Practice Address - Street 1:85 SIERRA PARK RD
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-0660
Practice Address - Country:US
Practice Address - Phone:760-924-4044
Practice Address - Fax:760-924-4125
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW196282NC0060X, 282NR1301X, 176B00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282NR1301XHospitalsGeneral Acute Care HospitalRural
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner