Provider Demographics
NPI:1467685420
Name:GAGLIARDI, KAREN JOAN (CRNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JOAN
Last Name:GAGLIARDI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 BROCK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5603
Mailing Address - Country:US
Mailing Address - Phone:215-493-7842
Mailing Address - Fax:
Practice Address - Street 1:1576 BROCK CREEK DR
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5603
Practice Address - Country:US
Practice Address - Phone:267-987-7509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010395163WG0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMG2194710OtherDEA