Provider Demographics
NPI:1104354315
Name:VINCENT, KAREN LYNM (LPN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNM
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:KELLEHER
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:830 HOOSICK RD APT 1
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6631
Mailing Address - Country:US
Mailing Address - Phone:518-265-4336
Mailing Address - Fax:
Practice Address - Street 1:830 HOOSICK RD APT 1
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-265-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324349164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse