Provider Demographics
NPI:1407997083
Name:LIBERATORE, KAREN CERJAK (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:CERJAK
Last Name:LIBERATORE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:CERJAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2720 SUNSET BLVD
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4810
Mailing Address - Country:US
Mailing Address - Phone:803-936-7679
Mailing Address - Fax:
Practice Address - Street 1:2720 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4810
Practice Address - Country:US
Practice Address - Phone:803-791-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 1426367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1034Medicaid