Basic Information
| Provider Information | |||||||||
| NPI: | 1770225310 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOGLE | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1092 MAGEE RD | ||||||||
| Address2: | |||||||||
| City: | PATTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166687405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145056347 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3438 ROUTE 764 | ||||||||
| Address2: | |||||||||
| City: | DUNCANSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166357803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149447000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2022 | ||||||||
| LastUpdateDate: | 04/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 295521 | PR | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.