Provider Demographics
NPI:1932473485
Name:LOGULLO, KAREN J (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:LOGULLO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:J
Other - Last Name:EGIZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 650782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0782
Mailing Address - Country:US
Mailing Address - Phone:302-733-0806
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:701 N CLAYTON ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3518
Practice Address - Country:US
Practice Address - Phone:302-421-4330
Practice Address - Fax:302-421-4331
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL6-0A00631367500000X
NJ26NJ00366200367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE088734OtherAANA NUMBER
NJ26NR15462900OtherRN LICENSE
DEL1-0033257OtherRN LICENSE
NJ26NR15462900OtherRN LICENSE
NJ238453Medicare PIN