Provider Demographics
NPI:1164429452
Name:NEMJO, KAREN SUE (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:NEMJO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:NEMJO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-748-8632
Mailing Address - Fax:
Practice Address - Street 1:2517 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2409
Practice Address - Country:US
Practice Address - Phone:360-748-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004896367500000X
OR367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR138921Medicare PIN
WAG8867437Medicare PIN
WAG8867442Medicare PIN
WAG8867439Medicare PIN
WAG8867441Medicare PIN
AKK161356Medicare PIN
ID1605073Medicare PIN
WAG8867440Medicare PIN
WAG8867438Medicare PIN
OR38-0091Medicare ID - Type UnspecifiedHMO, NURSE ANESTHETIST