Provider Demographics
NPI:1922305770
Name:SPENS, KARL G (CRNA)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:G
Last Name:SPENS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SW CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2772
Mailing Address - Country:US
Mailing Address - Phone:706-717-0563
Mailing Address - Fax:
Practice Address - Street 1:820 SW CENTER ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2772
Practice Address - Country:US
Practice Address - Phone:706-717-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN187510367500000X
IDRNA-786367500000X
WAAP 60207652367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered