Provider Demographics
NPI:1104862614
Name:ADU, KARLA RENEE (CNP)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:RENEE
Last Name:ADU
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:RENEE
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:122 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43019-1266
Mailing Address - Country:US
Mailing Address - Phone:740-694-1261
Mailing Address - Fax:740-694-7145
Practice Address - Street 1:122 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:OH
Practice Address - Zip Code:43019-1266
Practice Address - Country:US
Practice Address - Phone:740-694-1261
Practice Address - Fax:740-694-7145
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.284676-COA1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2407827Medicaid
OH2407827Medicaid