Provider Demographics
NPI:1114999190
Name:LANDIS, KAREN A (CRNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:LANDIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:STE. 110B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:401 N 17TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5034
Practice Address - Country:US
Practice Address - Phone:610-432-6862
Practice Address - Fax:484-403-4022
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PATP004197B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P24399Medicare UPIN
PA045378Medicare PIN