Basic Information
| Provider Information | |||||||||
| NPI: | 1730404492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKEAN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | JAYNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1808 BURLINGAME AVE SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495091229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162478364 | ||||||||
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| Practice Location | |||||||||
| Address1: | 277 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | ALLEGAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490101138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696735092 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2010 | ||||||||
| LastUpdateDate: | 04/06/2010 | ||||||||
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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 | 171M00000X | 6802061533 | MI | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.