Provider Demographics
NPI:1285660860
Name:KRUSTAPENTUS, KAREN L (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:KRUSTAPENTUS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2150 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-739-5676
Mailing Address - Fax:413-739-2278
Practice Address - Street 1:701 ENFIELD ST
Practice Address - Street 2:SPRINGFIELD MEDICAL ASSOCIATES
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-2961
Practice Address - Country:US
Practice Address - Phone:860-741-6058
Practice Address - Fax:860-741-6864
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163873363L00000X
CT000912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3080OtherBLUE CROSS
P00456576Medicare PIN
MAUX6474Medicare PIN
P25531Medicare UPIN
MANP3080Medicare ID - Type Unspecified