Provider Demographics
NPI:1437151198
Name:STRASEN, KARYN MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:KARYN
Middle Name:MICHELLE
Last Name:STRASEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 364
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:907-225-7346
Mailing Address - Fax:
Practice Address - Street 1:275 EAST 200 SOUTH
Practice Address - Street 2:VISTA STAFFING SOLUTIONS
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111
Practice Address - Country:US
Practice Address - Phone:800-366-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61008208600000X
CAG061008208600000X
AK05790208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G610080Medicaid
E-85731Medicare UPIN
W110389Medicare ID - Type Unspecified
CA00G610080Medicaid