Provider Demographics
NPI:1487611174
Name:BASILE, KAREN MARIE (AP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:BASILE
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 VIKINGS LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-4150
Mailing Address - Country:US
Mailing Address - Phone:904-249-2118
Mailing Address - Fax:
Practice Address - Street 1:217 1ST ST
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-6145
Practice Address - Country:US
Practice Address - Phone:904-249-2118
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2105171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist