Provider Demographics
NPI:1922063379
Name:QUEALY, KAREN (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:QUEALY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:20 MEDICAL VILLAGE DRIVE #258
Mailing Address - Street 2:OHIO VALLEY ANESTHESIA LLC
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:3131 QUEEN CITY AVENUE
Practice Address - Street 2:OHIO VALLEY ANETHESIA LLC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH152025367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0783291Medicaid
74004763OtherINDIANA MEDICAID
000000230806OtherANTHEM BLUE SHIELD
KY74004763OtherMEDICAID
OHQU8206685Medicare ID - Type Unspecified
KY74004763OtherMEDICAID