Basic Information
Provider Information
NPI: 1699341925
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PFEIL
FirstName: KAREN
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 50505 SCHOENHERR RD STE 340
Address2:  
City: SHELBY TOWNSHIP
State: MI
PostalCode: 483153140
CountryCode: US
TelephoneNumber: 5867318400
FaxNumber: 5867318406
Practice Location
Address1: 50505 SCHOENHERR RD STE 340
Address2:  
City: SHELBY TOWNSHIP
State: MI
PostalCode: 483153140
CountryCode: US
TelephoneNumber: 5867318400
FaxNumber: 5867318406
Other Information
ProviderEnumerationDate: 05/27/2021
LastUpdateDate: 05/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X4704310143MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home