Provider Demographics
NPI:1720877301
Name:KARL, TANYA D (RN, OWNER)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:D
Last Name:KARL
Suffix:
Gender:F
Credentials:RN, OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-3306
Mailing Address - Country:US
Mailing Address - Phone:608-346-6125
Mailing Address - Fax:
Practice Address - Street 1:1345 GRANT ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3306
Practice Address - Country:US
Practice Address - Phone:608-346-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 372500000X, 372600000X
WI16920530163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion