Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 5101016549 | MI |
N | 111NI0900X | Internist | 5101016549 | MI |
Y | 207RC0000X | Internist - Cardiovascular Disease | 036140067 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | 071651 | GA |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 5101016549 | MI |
NPI | 1174733224 |
---|---|
Provider Name | Dr. Karen P. Wiarda |
First Address | Urbana, IL 61801-2500 |
Second Address | Mattoon, IL 61938-9384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 20/08/2016 |