Provider Demographics
NPI:1932542297
Name:MCKINNON, KAREN ROSELYN (LPN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ROSELYN
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 TOMPKINS AVE
Mailing Address - Street 2:APT 3C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5629
Mailing Address - Country:US
Mailing Address - Phone:704-352-4786
Mailing Address - Fax:
Practice Address - Street 1:99 TOMPKINS AVE
Practice Address - Street 2:APT 3C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5629
Practice Address - Country:US
Practice Address - Phone:704-352-4786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155501164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse