Basic Information
| Provider Information | |||||||||
| NPI: | 1467442137 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THEN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | RN, CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 SIXTH AVE N | ||||||||
| Address2: | CENTRACARE CLINIC | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563032735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202525131 | ||||||||
| FaxNumber: | 3202402118 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 SIXTH AVE N | ||||||||
| Address2: | CENTRACARE CLINIC | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563032735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202525131 | ||||||||
| FaxNumber: | 3202402118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 08/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | R0992639 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 363LG0600X | R099263-9 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 122228 | 01 | U CARE | OTHER | 227323300 | 01 | MEDICAL ASSISTANCE | OTHER | 0400764 | 01 | MEDICA HEALTH PLANS | OTHER | 41Q38CO | 01 | BCBS | OTHER | 500002461 | 01 | RR MEDICARE | OTHER | HP25440 | 01 | HEALTH PARTNERS | OTHER |