Provider Demographics
NPI:1063767507
Name:WILTSE, KAREN JEAN (ANP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:JEAN
Last Name:WILTSE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 HURLEY PLZ
Mailing Address - Street 2:VASCULAR CLINIC
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5902
Mailing Address - Country:US
Mailing Address - Phone:810-262-4924
Mailing Address - Fax:810-262-9471
Practice Address - Street 1:1 HURLEY PLZ
Practice Address - Street 2:VASCULAR CLINIC
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-262-4924
Practice Address - Fax:810-262-9471
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704223678363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health