Basic Information
| Provider Information | |||||||||
| NPI: | 1487068995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALCZAK | ||||||||
| FirstName: | KAREN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2307 PEACH TREE LN | ||||||||
| Address2: | |||||||||
| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463111854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197302950 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3738 LANDMARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479056655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7658072780 | ||||||||
| FaxNumber: | 7658072781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 28138592A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.