Provider Demographics
NPI:1043374325
Name:GENSON, KAREN CARLSON (RD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:CARLSON
Last Name:GENSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N ATKINSON DR
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1906
Mailing Address - Country:US
Mailing Address - Phone:231-845-2369
Mailing Address - Fax:231-845-1732
Practice Address - Street 1:1 N ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1906
Practice Address - Country:US
Practice Address - Phone:231-845-2369
Practice Address - Fax:231-845-1732
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000312A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN941050LLLMedicare PIN