Provider Demographics
NPI:1669413746
Name:HITESMAN, KAREN (CRNA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HITESMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 ROANOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH050003-23-11367500000X
VA0024158114367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008972Medicaid
VT59020OtherBLUE CROSS BLUE SHIELD
NH40Y003915NH01OtherBLUE CROSS BLUE SHIELD
NH5414112OtherCIGNA HEALTHCARE
NHS43604OtherHARVARD PILGRIM HEALTHCAR
NH80300008Medicaid
NHS43604OtherHARVARD PILGRIM HEALTHCAR
NH80300008Medicaid