Provider Demographics
NPI:1922015866
Name:O'BLOCK, KAREN JAYNE (ANP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JAYNE
Last Name:O'BLOCK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:JAYNE
Other - Last Name:MERWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:1640 COWLES ST.
Mailing Address - Street 2:SUITE #1
Mailing Address - City:FARIBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701
Mailing Address - Country:US
Mailing Address - Phone:907-452-4768
Mailing Address - Fax:907-452-1009
Practice Address - Street 1:1640 COWLES ST.
Practice Address - Street 2:SUITE #1
Practice Address - City:FARIBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-452-4768
Practice Address - Fax:907-452-1009
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0000Medicare UPIN