Karmen Rae Dezeeuw, ATC

Primary specialty

Orthopedic AssistantTaxonomy code 246ZX2200X

License

2481 Issued in MN

Practice address

8624 Wedgewood LN N
Maple Grove, MN 55369-4615

Phone

(605) 553-5762

NPI assigned

Nov 4, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415059200000",
    "number": "1497150395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8624 WEDGEWOOD LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694615",
            "telephone_number": "605-553-5762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8624 WEDGEWOOD LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694615",
            "telephone_number": "605-553-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEZEEUW",
        "first_name": "KARMEN",
        "middle_name": "RAE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-04",
        "last_updated": "2014-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "2481",
            "primary": false
        },
        {
            "code": "246ZX2200X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Orthopedic Assistant",
            "state": "MN",
            "license": "2481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Specialists of Minnesota, PLLC
• Dentalign P.a.
• Derm on Demand LLC
• Phillip John Detlefsen, D.C.
• Parker Deutz, DPT
• Sonia Anil Dhumne, DDS
• Safiatou Diallo
• Thaily Diaz Fleites, DDS
• Marie A Diaz Varona, PSYD, LP
• Catherine Didur

• Other Specialist/Technologist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Other Specialist/Technologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.