Provider Demographics
NPI:1184676173
Name:PAVLICK, KAREN M (CRNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:PAVLICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 HARLEYSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2210
Mailing Address - Country:US
Mailing Address - Phone:215-256-8040
Mailing Address - Fax:
Practice Address - Street 1:484 HARLEYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2210
Practice Address - Country:US
Practice Address - Phone:215-256-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP006240B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS68007Medicare UPIN