Provider Demographics
NPI:1265523112
Name:GLANCE-SMITH, KAREN L (CRNA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:GLANCE-SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:GLANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3050 E AIRPORT WAY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2404
Mailing Address - Country:US
Mailing Address - Phone:562-426-9661
Mailing Address - Fax:562-426-4227
Practice Address - Street 1:8635 FIRESTONE BLVD
Practice Address - Street 2:STE # 100
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5242
Practice Address - Country:US
Practice Address - Phone:562-862-5121
Practice Address - Fax:562-862-3027
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2582367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN5614700OtherMEDI-CAL