Provider Demographics
NPI:1649408055
Name:URSIC, KAREN S (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:URSIC
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:800-888-9903
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:1331 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2799
Practice Address - Country:US
Practice Address - Phone:503-535-2883
Practice Address - Fax:503-535-2887
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201405484RN367500000X
HI1154367500000X
HI36247367500000X
OR201405485CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR223986OtherMCOR
WA2040572Medicaid