Provider Demographics
NPI:1104649565
Name:ENSTROM, KAREN (RN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ENSTROM
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 1:11383 KINGLET LN
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5713
Mailing Address - Country:US
Mailing Address - Phone:206-799-4285
Mailing Address - Fax:
Practice Address - Street 1:11383 KINGLET LN
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5713
Practice Address - Country:US
Practice Address - Phone:206-799-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00129610163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice