Provider Demographics
NPI:1164699633
Name:ZAJAC, KAREN HEROLD (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:HEROLD
Last Name:ZAJAC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 DOUGLAS BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3846
Mailing Address - Country:US
Mailing Address - Phone:916-788-1550
Mailing Address - Fax:
Practice Address - Street 1:3013 DOUGLAS BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3846
Practice Address - Country:US
Practice Address - Phone:916-788-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 18120363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology