Provider Demographics
NPI:1447474358
Name:CHARBONNEAU, KAREN LEE (RN MS)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:CHARBONNEAU
Suffix:
Gender:F
Credentials:RN MS
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LEE
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:710 HANCOCK RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-3016
Mailing Address - Country:US
Mailing Address - Phone:413-458-9862
Mailing Address - Fax:
Practice Address - Street 1:25 MARSHALL ST
Practice Address - Street 2:BRIEN CENTER
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2451
Practice Address - Country:US
Practice Address - Phone:413-398-1341
Practice Address - Fax:413-662-3311
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174890163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator