Provider Demographics
NPI:1265484083
Name:HERGENREDER, KAREN (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HERGENREDER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 JENNISON DR
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2409 CHERRY ST
Practice Address - Street 2:#305
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2625
Practice Address - Country:US
Practice Address - Phone:419-251-3740
Practice Address - Fax:419-251-3859
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.07590367500000X
OH215576174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2452911Medicaid
OH2452911Medicaid