Provider Demographics
NPI:1952156556
Name:ENNIS, KAREN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ENNIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PARK RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517
Mailing Address - Country:US
Mailing Address - Phone:203-507-0987
Mailing Address - Fax:
Practice Address - Street 1:528 WHEELERS FARMS RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-1847
Practice Address - Country:US
Practice Address - Phone:203-877-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT162109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse