Provider Demographics
NPI:1710709662
Name:FEDDERSEN, KAREN ANN (RN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:FEDDERSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 EQUESTRIAN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-5307
Mailing Address - Country:US
Mailing Address - Phone:616-403-6040
Mailing Address - Fax:
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2303
Practice Address - Country:US
Practice Address - Phone:734-845-3658
Practice Address - Fax:734-222-7174
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704241722163W00000X, 163WX0601X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0601XNursing Service ProvidersRegistered NurseOtorhinolaryngology & Head-Neck
No163W00000XNursing Service ProvidersRegistered Nurse