Provider Demographics
NPI:1780688663
Name:SUPPI, KAREN ANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNE
Last Name:SUPPI
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 1:554 N DUKE ST
Mailing Address - Street 2:STE. 2
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2225
Mailing Address - Country:US
Mailing Address - Phone:717-299-3524
Mailing Address - Fax:717-299-3552
Practice Address - Street 1:554 N DUKE ST
Practice Address - Street 2:STE.2
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2225
Practice Address - Country:US
Practice Address - Phone:717-299-3524
Practice Address - Fax:717-299-3552
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN235803L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085990Medicare ID - Type Unspecified