Provider Demographics
NPI:1730142043
Name:MATHIAS, KAREN (RN,CPNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:RN,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 KILBY SHORES DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6411
Mailing Address - Country:US
Mailing Address - Phone:757-934-7672
Mailing Address - Fax:
Practice Address - Street 1:1701 HIGH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3103
Practice Address - Country:US
Practice Address - Phone:757-393-8585
Practice Address - Fax:757-673-0927
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024049786363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics