Provider Demographics
NPI:1447441662
Name:ENGEL-THOMPSON, KAREN ANN III (APRN, BC, PHM)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:ENGEL-THOMPSON
Suffix:III
Gender:F
Credentials:APRN, BC, PHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3899
Mailing Address - Country:US
Mailing Address - Phone:410-224-2792
Mailing Address - Fax:410-263-9593
Practice Address - Street 1:4 RIGGS AVE
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3899
Practice Address - Country:US
Practice Address - Phone:410-224-2792
Practice Address - Fax:410-263-9593
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR079336364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD755QMedicare PIN