Provider Demographics
NPI:1437268455
Name:HAUDE, KAREN RUTH (MPAS PAC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RUTH
Last Name:HAUDE
Suffix:
Gender:F
Credentials:MPAS PAC
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:HAUDE
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS PAC
Mailing Address - Street 1:1038 DELL CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-3252
Mailing Address - Country:US
Mailing Address - Phone:330-494-2072
Mailing Address - Fax:330-494-2072
Practice Address - Street 1:4240 MUNSON ST NW
Practice Address - Street 2:SUITE B
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-492-2327
Practice Address - Fax:330-492-0953
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001125363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
97WCCPTMedicare ID - Type Unspecified
S53675Medicare UPIN
OHPA29531Medicare PIN