Provider Demographics
NPI:1669739348
Name:BRANSTROM, KAREN (RT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BRANSTROM
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12210 FRIDAY Q.1 RD
Mailing Address - Street 2:
Mailing Address - City:RAPID RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49878-9782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12210 FRIDAY Q.1 RD
Practice Address - Street 2:
Practice Address - City:RAPID RIVER
Practice Address - State:MI
Practice Address - Zip Code:49878-9782
Practice Address - Country:US
Practice Address - Phone:906-630-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4408162471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography