Provider Demographics
NPI:1437409331
Name:BAMBERG, KAREN E (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:E
Last Name:BAMBERG
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 ALDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-7067
Mailing Address - Country:US
Mailing Address - Phone:912-427-7350
Mailing Address - Fax:912-427-7315
Practice Address - Street 1:113 COLONIAL WAY
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0122
Practice Address - Country:US
Practice Address - Phone:912-427-7350
Practice Address - Fax:912-427-7315
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118292363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health