Provider Demographics
NPI:1801531579
Name:TYSON, KAREN J (ND)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:TYSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 588
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:CT
Mailing Address - Zip Code:06063-0588
Mailing Address - Country:US
Mailing Address - Phone:860-810-6646
Mailing Address - Fax:
Practice Address - Street 1:22 RIVER RD
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:CT
Practice Address - Zip Code:06063-3315
Practice Address - Country:US
Practice Address - Phone:860-810-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT710175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath