Provider Demographics
NPI:1174625149
Name:HARTZEL, KAREN S (NP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:S
Last Name:HARTZEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:S
Other - Last Name:BAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1510 SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-0000
Mailing Address - Country:US
Mailing Address - Phone:618-283-3144
Mailing Address - Fax:618-283-3194
Practice Address - Street 1:1510 SUNSET DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-3228
Practice Address - Country:US
Practice Address - Phone:618-283-3144
Practice Address - Fax:618-283-3194
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041164815163W00000X
IL209002179367A00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP85381Medicare UPIN