Individual
MRS. KAREN D WANTUCH
Active
Individual
MRS. KAREN D WANTUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
169316
NC
363LF0000X
Family Nurse Practitioner
F0712525
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7006658
—
NC
01
—
NCB931A2342423A
MEDICARE PIN
NC
Enumeration date
01/11/2013
Last updated
01/13/2021
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