Basic Information
| Provider Information | |||||||||
| NPI: | 1831721505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIDRICKSON | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | RN, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 960 S. WOODCREST CIRCLE | ||||||||
| Address2: | |||||||||
| City: | WASILLA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077074135 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 670 W FIREWEED LN STE 160 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995032561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077700862 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2020 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 11434 | AK | Y | Nursing Service Providers | Registered Nurse |
No ID Information.