Provider Demographics
NPI:1265434179
Name:ABBOTT, KAREN RAE (MD)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RAE
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WESTMOANA LANE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-322-8883
Mailing Address - Fax:775-827-8813
Practice Address - Street 1:1101 WEST MOANA LANE
Practice Address - Street 2:SUITE 8
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-322-8883
Practice Address - Fax:775-827-8813
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2015-09-15
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
NV11149174400000X, 207VG0400X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
V101088Medicare UPIN