Basic Information
Provider Information
NPI: 1164818076
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: KAREN
MiddleName:  
NamePrefix: MISS
NameSuffix:  
Credential: APN, CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6225 N STATE HIGHWAY 161 STE 200
Address2:  
City: IRVING
State: TX
PostalCode: 750382241
CountryCode: US
TelephoneNumber: 2146870001
FaxNumber:  
Practice Location
Address1: 1423 CHICAGO RD
Address2:  
City: CHICAGO HEIGHTS
State: IL
PostalCode: 604113400
CountryCode: US
TelephoneNumber: 7087561000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/08/2015
LastUpdateDate: 04/08/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X209012652ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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