Provider Demographics
NPI:1588604755
Name:ALTOBELLI, KAREN (CRNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ALTOBELLI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:KRYLOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 CITY LINE AVENUE
Mailing Address - Street 2:SUITE 930
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004
Mailing Address - Country:US
Mailing Address - Phone:610-667-7525
Mailing Address - Fax:610-667-9970
Practice Address - Street 1:9501 ROOSEVELT BOULEVARD
Practice Address - Street 2:SUITE 314
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-969-9511
Practice Address - Fax:215-969-9512
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006912C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074435OtherBLUE SHIELD
PA074435OtherBLUE SHIELD
P55589Medicare UPIN