Provider Demographics
NPI:1184659666
Name:HARE, KARL WHITMAN (CRNA)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:WHITMAN
Last Name:HARE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 SE TECH CENTER PL STE 385
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5508
Mailing Address - Country:US
Mailing Address - Phone:360-360-2244
Mailing Address - Fax:360-360-2244
Practice Address - Street 1:1498 SE TECH CENTER PL STE 385
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5508
Practice Address - Country:US
Practice Address - Phone:360-360-2244
Practice Address - Fax:360-360-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007561367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1624711003Medicaid
TX86084UOtherBC BS INDIV PROV SPECT GP
TX8F1592Medicare ID - Type UnspecifiedINDIV PROV SPECTRUM GP
TX1624711003Medicaid